Healthcare Provider Details

I. General information

NPI: 1306026729
Provider Name (Legal Business Name): NACOGDOCHES COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 ELYSIAN FIELDS ROAD
MARSHALL TX
75672-2083
US

IV. Provider business mailing address

1204 N MOUND ST
NACOGDOCHES TX
75961-4027
US

V. Phone/Fax

Practice location:
  • Phone: 903-935-6700
  • Fax: 903-935-6702
Mailing address:
  • Phone: 936-568-8523
  • Fax: 936-568-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: RONALD R PAYNE
Title or Position: MANAGER
Credential:
Phone: 469-916-6100