Healthcare Provider Details

I. General information

NPI: 1437486867
Provider Name (Legal Business Name): FANNIN COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 LIPSCOMB ST BONHAM PAIN MANAGEMENT CLINIC
BONHAM TX
75418-4027
US

IV. Provider business mailing address

DRAWER C
BONHAM TX
75418-0180
US

V. Phone/Fax

Practice location:
  • Phone: 903-640-4809
  • Fax: 903-640-7601
Mailing address:
  • Phone: 903-640-7311
  • Fax: 903-640-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAY J HODGES
Title or Position: CFO
Credential:
Phone: 903-640-7311