Provider Demographics
NPI:1811290588
Name:TM VAN ZANDT HOSPITAL LLC
Entity type:Organization
Organization Name:TM VAN ZANDT HOSPITAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-697-6591
Mailing Address - Street 1:749 N WALDRIP ST
Mailing Address - Street 2:
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140-1555
Mailing Address - Country:US
Mailing Address - Phone:254-697-6591
Mailing Address - Fax:254-697-8326
Practice Address - Street 1:707 N WALDRIP ST
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-1555
Practice Address - Country:US
Practice Address - Phone:254-697-6591
Practice Address - Fax:254-697-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092351802Medicaid
TX458776Medicare Oscar/Certification