Provider Demographics
NPI:1922009331
Name:GAINESVILLE HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:GAINESVILLE HOSPITAL DISTRICT
Other - Org Name:NORTH TEXAS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BACUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-665-1751
Mailing Address - Street 1:1900 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-2002
Mailing Address - Country:US
Mailing Address - Phone:940-665-1751
Mailing Address - Fax:940-612-8601
Practice Address - Street 1:1900 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-2002
Practice Address - Country:US
Practice Address - Phone:940-665-1751
Practice Address - Fax:940-612-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000298282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121777003Medicaid
TXHH0515OtherBLUE CROSS BLUE SHIELD ID
TX121777002Medicaid
TX121777003Medicaid