MEDICARE: HAMILTON COUNTY 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

General Provider Information

NPI Number	:	1558984278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMILTON COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	206 HALEY RD
Second Line	:
City	:	JOHNSON CITY
State	:	TX
Zip	:	78636-4617
Country	:	US
Telephone Number	:	830-868-4093
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 HALEY RD
Second Line	:
City	:	JOHNSON CITY
State	:	TX
Zip	:	78636-4617
Country	:	US
Telephone Number	:	830-868-4093
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GRADY HOOPER
Credential	:
Telephone Number	:	254-386-1950

Provider Enumeration Date	:	05/28/2020
Last Update Date	:	03/23/2021

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