Healthcare Provider Details

I. General information

NPI: 1366963654
Provider Name (Legal Business Name): FANNIN COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S HALL ST
ENNIS TX
75119-6318
US

IV. Provider business mailing address

504 LIPSCOMB ST
BONHAM TX
75418-4028
US

V. Phone/Fax

Practice location:
  • Phone: 972-875-9051
  • Fax:
Mailing address:
  • Phone: 903-583-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CLARK SANDERSON
Title or Position: PRESIDENT
Credential:
Phone: 903-583-1854