Provider Demographics
NPI:1881742179
Name:GENERAL HOSPITAL
Entity type:Organization
Organization Name:GENERAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACTING CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-639-2575
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:IRAAN
Mailing Address - State:TX
Mailing Address - Zip Code:79744-0665
Mailing Address - Country:US
Mailing Address - Phone:432-639-3438
Mailing Address - Fax:432-639-6253
Practice Address - Street 1:600 HWY 349 NORTH
Practice Address - Street 2:
Practice Address - City:IRAAN
Practice Address - State:TX
Practice Address - Zip Code:79744-0665
Practice Address - Country:US
Practice Address - Phone:432-639-3438
Practice Address - Fax:432-639-6253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 2083P0901X, 207Q00000X
TX000258261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105375100OtherFIRST CARE PROVIDER NUMBE
TX112728404Medicaid
TX112728401Medicaid
TX00BW33OtherBLUE CROSS PROVIDER NUMBE
TX112728401Medicaid