Provider Demographics
NPI:1841254174
Name:DEWITT MEDICAL DISTRICT
Entity type:Organization
Organization Name:DEWITT MEDICAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CRO
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 1:2550 N ESPLANADE ST
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-4736
Mailing Address - Country:US
Mailing Address - Phone:361-275-6191
Mailing Address - Fax:361-275-3999
Practice Address - Street 1:3130 S BRAHMA BLVD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7257
Practice Address - Country:US
Practice Address - Phone:361-592-8700
Practice Address - Fax:361-592-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115826313M00000X
TX675815314000000X
TX3868670001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360973701Medicaid
TXHH076SOtherBCBS BLUELINK
TX001026483Medicaid
TX539801Medicaid
TX011176702Medicaid
TX001000653Medicaid
TX001000653Medicaid
TX3868670001Medicare NSC