Provider Demographics
NPI:1902840333
Name:SHERMAN GRAYSON HOSPITAL LLC
Entity Type:Organization
Organization Name:SHERMAN GRAYSON HOSPITAL LLC
Other - Org Name:D/B/A HEALTHCENTER ON 1417
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-870-4591
Mailing Address - Street 1:119 W HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5909
Mailing Address - Country:US
Mailing Address - Phone:903-891-7000
Mailing Address - Fax:903-813-1479
Practice Address - Street 1:1000 S FM 1417
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-4865
Practice Address - Country:US
Practice Address - Phone:903-870-4611
Practice Address - Fax:903-891-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U24JOtherBLUE CROSS BLUE SHIELD
TX018042401OtherTX MEDICAID T-STEPS
TX063537701Medicaid
TX018042401OtherTX MEDICAID T-STEPS