Healthcare Provider Details

I. General information

NPI: 1851408561
Provider Name (Legal Business Name): FANNIN COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 LIPSCOMB ST P. O. DRAWER C
BONHAM TX
75418-4028
US

IV. Provider business mailing address

504 LIPSCOMB ST P. O. DRAWER C
BONHAM TX
75418-4028
US

V. Phone/Fax

Practice location:
  • Phone: 903-583-8585
  • Fax: 903-640-7601
Mailing address:
  • Phone: 903-583-8585
  • Fax: 903-640-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number008231
License Number StateTX

VIII. Authorized Official

Name: JAY HODGES
Title or Position: CFO
Credential:
Phone: 903-583-8585