Healthcare Provider Details

I. General information

NPI: 1346281573
Provider Name (Legal Business Name): DEWITT MEDICAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N BROAD ST
LAMPASAS TX
76550-1105
US

IV. Provider business mailing address

611 N BROAD ST
LAMPASAS TX
76550-1105
US

V. Phone/Fax

Practice location:
  • Phone: 512-556-3588
  • Fax: 512-556-2507
Mailing address:
  • Phone: 512-556-3588
  • Fax: 512-556-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number115094
License Number StateTX

VIII. Authorized Official

Name: ALMA ALEXANDER
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 361-275-0504