Provider Demographics
NPI:1265577456
Name:COUNTY OF DEWITT OFFICE OF TREASURER
Entity type:Organization
Organization Name:COUNTY OF DEWITT OFFICE OF TREASURER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-578-6281
Mailing Address - Street 1:307 N GONZALES ST
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-2948
Mailing Address - Country:US
Mailing Address - Phone:361-275-0894
Mailing Address - Fax:361-275-0898
Practice Address - Street 1:115 N GONZALES ST
Practice Address - Street 2:STE B
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-2907
Practice Address - Country:US
Practice Address - Phone:361-275-0920
Practice Address - Fax:361-275-0924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0926503-01Medicaid
TXPH0028Medicare ID - Type UnspecifiedMEDICARE NUMBER