Provider Demographics
NPI:1912989807
Name:LLANO COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:LLANO COUNTY HOSPITAL AUTHORITY
Other - Org Name:LLANO MEMORIAL HOSPITAL EMERGENCY ROOM SVCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEEPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-247-7868
Mailing Address - Street 1:200 W OLLIE ST
Mailing Address - Street 2:
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643-2628
Mailing Address - Country:US
Mailing Address - Phone:325-247-5040
Mailing Address - Fax:325-248-2801
Practice Address - Street 1:200 W OLLIE ST
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-2628
Practice Address - Country:US
Practice Address - Phone:325-247-5040
Practice Address - Fax:325-248-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00297KOtherBCBS
TX00298KOtherBCBS
TX080322302Medicaid
TX00297KOtherBCBS