Healthcare Provider Details

I. General information

NPI: 1124495486
Provider Name (Legal Business Name): FANNIN COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 MARTIN LUTHER KING DR
JEFFERSON TX
75657-1009
US

IV. Provider business mailing address

1307 MARTIN LUTHER KING DR
JEFFERSON TX
75657-1009
US

V. Phone/Fax

Practice location:
  • Phone: 903-665-3951
  • 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