MEDICARE: DIMMIT REGIONAL HOSPITAL

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	208600000X	Surgery Physician	100064	TX
2	207V00000X	Obstetrics & Gynecology Physician	100064	TX

General Provider Information

NPI Number	:	1447523766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIMMIT REGIONAL HOSPITAL

Provider Business Mailing Address
First Line	:	704 HOSPITAL DR
Second Line	:
City	:	CARRIZO SPRINGS
State	:	TX
Zip	:	78834-3836
Country	:	US
Telephone Number	:	830-876-2424
Fax Number	:	830-876-5774

Provider Business Practice Location Address
First Line	:	704 HOSPITAL DR
Second Line	:
City	:	CARRIZO SPRINGS
State	:	TX
Zip	:	78834-3836
Country	:	US
Telephone Number	:	830-876-2424
Fax Number	:	830-876-5774

Authorized Official
Title or Position	:	CEO/ADMINISTRATOR
Name	:	MR. ERNEST FLORES JR.
Credential	:
Telephone Number	:	830-876-2424

Provider Enumeration Date	:	02/16/2012
Last Update Date	:	02/16/2012

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Directions to “DIMMIT REGIONAL HOSPITAL ” Practice Location

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