Provider Demographics
NPI:1831567122
Name:DEWITT MEDICAL DISTRICT
Entity type:Organization
Organization Name:DEWITT MEDICAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-275-6191
Mailing Address - Street 1:139 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:GOLIAD
Mailing Address - State:TX
Mailing Address - Zip Code:77963-4281
Mailing Address - Country:US
Mailing Address - Phone:361-645-8235
Mailing Address - Fax:
Practice Address - Street 1:139 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:GOLIAD
Practice Address - State:TX
Practice Address - Zip Code:77963-4281
Practice Address - Country:US
Practice Address - Phone:361-645-8235
Practice Address - Fax:361-645-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX357774401Medicaid
TX363141801OtherMEDICAID RHC
TX363141802OtherTHSTEPS RHC MEDICAID
TX363141802OtherTHSTEPS RHC MEDICAID
TX673433Medicare PIN