Healthcare Provider Details

I. General information

NPI: 1215438601
Provider Name (Legal Business Name): FANNIN COUNTY HOSPITAL AUTORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 DESHONG DR
PARIS TX
75460-9318
US

IV. Provider business mailing address

504 LIPSCOMB ST
BONHAM TX
75418-4028
US

V. Phone/Fax

Practice location:
  • Phone: 903-706-5035
  • Fax: 903-706-5036
Mailing address:
  • Phone: 903-583-8585
  • Fax: 903-640-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateTX

VIII. Authorized Official

Name: TIFFANY CAMP
Title or Position: DIRECTOR, QUALITY
Credential:
Phone: 903-640-7301