Healthcare Provider Details

I. General information

NPI: 1447325543
Provider Name (Legal Business Name): KNOX COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 SE 5TH ST
KNOX CITY TX
79529-2105
US

IV. Provider business mailing address

PO BOX 488 712 S 5TH
KNOX CITY TX
79529-0488
US

V. Phone/Fax

Practice location:
  • Phone: 940-657-3906
  • Fax: 940-657-3909
Mailing address:
  • Phone: 940-657-3906
  • Fax: 940-657-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: KELLY MYERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 940-657-3906