MEDICARE: NOCONA HOSPITAL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	144234	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053783639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOCONA HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	3326 BURGOYNE ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75233-1304
Country	:	US
Telephone Number	:	214-330-9291
Fax Number	:	214-331-2924

Provider Business Practice Location Address
First Line	:	3326 BURGOYNE ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75233-1304
Country	:	US
Telephone Number	:	214-330-9291
Fax Number	:	214-331-2924

Authorized Official
Title or Position	:	CEO
Name	:	MR. LANCE MEEKINS
Credential	:
Telephone Number	:	940-825-3235

Provider Enumeration Date	:	10/22/2015
Last Update Date	:	03/30/2016

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