Healthcare Provider Details

I. General information

NPI: 1629351390
Provider Name (Legal Business Name): DIMMIT REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 HOSPITAL DR
CARRIZO SPRINGS TX
78834-3836
US

IV. Provider business mailing address

PO BOX 1016
CARRIZO SPRINGS TX
78834-7016
US

V. Phone/Fax

Practice location:
  • Phone: 830-876-2424
  • Fax: 830-876-5774
Mailing address:
  • Phone: 830-876-2424
  • Fax: 830-876-5774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberN7201
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberJ7667
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberJ7667
License Number StateTX

VIII. Authorized Official

Name: MR. ERNEST FLORES JR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 830-876-2424