Provider Demographics
NPI:1184695785
Name:JOURDANTON HOSPITAL CORPORATION
Entity type:Organization
Organization Name:JOURDANTON HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:PO BOX 847974
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7974
Mailing Address - Country:US
Mailing Address - Phone:830-769-3515
Mailing Address - Fax:830-769-5264
Practice Address - Street 1:1905 HIGHWAY 97 E
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-1504
Practice Address - Country:US
Practice Address - Phone:830-769-3515
Practice Address - Fax:830-769-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000334282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
178476300OtherDEPT OF LABOR
121780403OtherCHILDRENS SPECIAL NEEDS
TX121780403Medicaid
TX121780402Medicaid
620010OtherFIRST HEALTH
450165OtherAETNA
HH0154OtherBCBS
620010OtherFIRST HEALTH
TX450165Medicare Oscar/Certification