Healthcare Provider Details

I. General information

NPI: 1417356809
Provider Name (Legal Business Name): DEWITT MEDICAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HOSPITAL DR
CUERO TX
77954-6400
US

IV. Provider business mailing address

105 HOSPITAL DR
CUERO TX
77954-6400
US

V. Phone/Fax

Practice location:
  • Phone: 361-275-3421
  • Fax: 361-275-8640
Mailing address:
  • Phone: 361-275-3421
  • Fax: 361-275-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. GREG PRITCHETT
Title or Position: CFO
Credential:
Phone: 361-275-0504