Healthcare Provider Details

I. General information

NPI: 1386857415
Provider Name (Legal Business Name): HONDO HOSPTIAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 AVE E
HONDO TX
78861
US

IV. Provider business mailing address

3200 AVE E
HONDO TX
78861
US

V. Phone/Fax

Practice location:
  • Phone: 830-426-7444
  • Fax:
Mailing address:
  • Phone: 830-426-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICA GUTIERREZ
Title or Position: MEDICAID BILLING
Credential:
Phone: 830-426-7891