Healthcare Provider Details

I. General information

NPI: 1033191655
Provider Name (Legal Business Name): LLANO COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 HWY 1431
KINGSLAND TX
78639-6010
US

IV. Provider business mailing address

200 W OLLIE ST
LLANO TX
78643-2628
US

V. Phone/Fax

Practice location:
  • Phone: 325-388-3515
  • Fax:
Mailing address:
  • Phone: 325-247-5040
  • Fax: 325-248-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number000476
License Number StateTX

VIII. Authorized Official

Name: MR. KEVIN A LEEPER
Title or Position: CEO
Credential:
Phone: 325-247-7868