Healthcare Provider Details

I. General information

NPI: 1669468617
Provider Name (Legal Business Name): SOUTH LIMESTONE HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MCCLINTIC DR
GROESBECK TX
76642-2128
US

IV. Provider business mailing address

701 MCCLINTIC DR
GROESBECK TX
76642-2128
US

V. Phone/Fax

Practice location:
  • Phone: 254-729-3411
  • Fax: 254-729-3258
Mailing address:
  • Phone: 254-729-3411
  • Fax: 254-729-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number000052
License Number StateTX

VIII. Authorized Official

Name: MR. LARRY PRICE
Title or Position: ADMINISTRATOR
Credential:
Phone: 254-729-3411