Healthcare Provider Details

I. General information

NPI: 1053487868
Provider Name (Legal Business Name): DEWITT MEDICAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N ESPLANADE ST
CUERO TX
77954
US

IV. Provider business mailing address

615 N ESPLANADE ST
CUERO TX
77954-3605
US

V. Phone/Fax

Practice location:
  • Phone: 361-275-8999
  • Fax: 361-275-8970
Mailing address:
  • Phone: 361-275-8999
  • Fax: 361-275-8970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1140
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARGARET KRAUSE
Title or Position: HOME CARE ADMINISTRATOR
Credential: RN
Phone: 361-275-8999