Provider Demographics
NPI:1295054161
Name:DIMMIT REGIONAL HOSPITAL
Entity type:Organization
Organization Name:DIMMIT REGIONAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:830-876-2424
Mailing Address - Street 1:707 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-3844
Mailing Address - Country:US
Mailing Address - Phone:830-876-2424
Mailing Address - Fax:830-876-3099
Practice Address - Street 1:707 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CARRIZO SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78834-3844
Practice Address - Country:US
Practice Address - Phone:830-876-2424
Practice Address - Fax:830-876-3099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIMMIT REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-18
Last Update Date:2013-05-14
Deactivation Date:2011-02-22
Deactivation Code:
Reactivation Date:2011-03-09
Provider Licenses
StateLicense IDTaxonomies
TX015248251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217884003Medicaid
TX457760Medicare Oscar/Certification