MEDICARE: FANNIN COUNTY HOSPITAL AUTHORITY

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		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	:	1649402603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FANNIN COUNTY HOSPITAL AUTHORITY

Provider Business Mailing Address
First Line	:	2265 S SYCAMORE ST
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-4774
Country	:	US
Telephone Number	:	903-723-2592
Fax Number	:	903-723-2673

Provider Business Practice Location Address
First Line	:	2265 S SYCAMORE ST
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-4774
Country	:	US
Telephone Number	:	903-723-2592
Fax Number	:	903-723-2673

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLARK SANDERSON
Credential	:
Telephone Number	:	903-583-1854

Provider Enumeration Date	:	08/10/2009
Last Update Date	:	04/10/2026

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Directions to “FANNIN COUNTY HOSPITAL AUTHORITY ” Practice Location

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