Provider Demographics
NPI:1720197270
Name:TITUS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:TITUS COUNTY HOSPITAL DISTRICT
Other - Org Name:NEPHROLOGY & FAMILY PRACTICE AT TITUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SCOGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-577-6066
Mailing Address - Street 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2371
Mailing Address - Country:US
Mailing Address - Phone:903-572-6032
Mailing Address - Fax:903-572-6341
Practice Address - Street 1:203 W 20TH ST STE C
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-1103
Practice Address - Country:US
Practice Address - Phone:903-434-7080
Practice Address - Fax:903-434-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676130Medicare Oscar/Certification