Provider Demographics
NPI:1831299031
Name:HOOD COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:HOOD COUNTY HOSPITAL DISTRICT
Other - Org Name:LAKE GRANBURY FAMILY PRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-579-1642
Mailing Address - Street 1:1322 PALUXY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5603
Mailing Address - Country:US
Mailing Address - Phone:817-579-1642
Mailing Address - Fax:817-579-9926
Practice Address - Street 1:1322 PALUXY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5603
Practice Address - Country:US
Practice Address - Phone:817-579-1642
Practice Address - Fax:817-579-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R57HMedicare ID - Type Unspecified