Provider Demographics
NPI:1891979167
Name:RENAISSANCE HOSPITAL TERREL INC
Entity Type:Organization
Organization Name:RENAISSANCE HOSPITAL TERREL INC
Other - Org Name:WILLS POINT RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMESNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-886-1900
Mailing Address - Street 1:14440 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-5300
Mailing Address - Country:US
Mailing Address - Phone:832-886-1900
Mailing Address - Fax:
Practice Address - Street 1:566 N 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-1616
Practice Address - Country:US
Practice Address - Phone:903-873-6161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENAISSANCE HOSPITAL TERRELL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458739Medicare PIN