Provider Demographics
NPI:1700834231
Name:SMITHVILLE HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:SMITHVILLE HOSPITAL AUTHORITY
Other - Org Name:SMITHVILLE HOSPITAL AUTHORITY DBA TOWERS NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOLGENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-237-4606
Mailing Address - Street 1:907 GARWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78957-1117
Mailing Address - Country:US
Mailing Address - Phone:512-237-4606
Mailing Address - Fax:512-360-4035
Practice Address - Street 1:907 GARWOOD ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TX
Practice Address - Zip Code:78957-1117
Practice Address - Country:US
Practice Address - Phone:512-237-4606
Practice Address - Fax:512-360-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117081314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000446802Medicaid
TX000446802Medicaid