MEDICARE: TYLER 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45-5538	OTHER	TX	MEDICARE CCN

General Provider Information

NPI Number	:	1659769420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYLER COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	1100 W BLUFF ST
Second Line	:
City	:	WOODVILLE
State	:	TX
Zip	:	75979-4738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 GULF AVE
Second Line	:
City	:	GROVES
State	:	TX
Zip	:	77619-3717
Country	:	US
Telephone Number	:	409-962-5785
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SANDRA WILLIAMS
Credential	:
Telephone Number	:	409-283-8141

Provider Enumeration Date	:	01/02/2015
Last Update Date	:	08/28/2025

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Directions to “TYLER COUNTY HOSPITAL DISTRICT ” Practice Location

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