Healthcare Provider Details

I. General information

NPI: 1790962447
Provider Name (Legal Business Name): LLANO COUNTY HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 AVE G
MARBLE FALLS TX
78654-5866
US

IV. Provider business mailing address

200 W OLLIE ST
LLANO TX
78643-2628
US

V. Phone/Fax

Practice location:
  • Phone: 830-693-8234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTEMPORARY
License Number StateTX

VIII. Authorized Official

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