Provider Demographics
NPI:1013957836
Name:SHERMAN GRAYSON HOSPITAL LLC
Entity type:Organization
Organization Name:SHERMAN GRAYSON HOSPITAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KITTY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-870-4615
Mailing Address - Street 1:500 N. HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7354
Mailing Address - Country:US
Mailing Address - Phone:903-870-4611
Mailing Address - Fax:903-891-2030
Practice Address - Street 1:500 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7354
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:2006-06-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75086404075092001OtherCHAMPUS
TXHH0108OtherBLUE CROSS BLUE SHIELD
TX138349908Medicaid
TXHH0108OtherBLUE CROSS BLUE SHIELD