Healthcare Provider Details

I. General information

NPI: 1184047599
Provider Name (Legal Business Name): FANNIN COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 N CENTER ST
BONHAM TX
75418-2627
US

IV. Provider business mailing address

PO BOX C
BONHAM TX
75418-0180
US

V. Phone/Fax

Practice location:
  • Phone: 903-449-4698
  • Fax:
Mailing address:
  • Phone: 903-640-7311
  • Fax: 903-640-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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