Healthcare Provider Details

I. General information

NPI: 1063681286
Provider Name (Legal Business Name): COMMUNITY GENERAL HOSPITAL OF DILLEY TEXAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E HACKBERRY ST
PEARSALL TX
78061-4412
US

IV. Provider business mailing address

105 HACKBERRY STREET
PEARSALL TX
78061-4412
US

V. Phone/Fax

Practice location:
  • Phone: 830-334-4016
  • Fax: 830-334-4055
Mailing address:
  • Phone: 830-334-4016
  • Fax: 830-334-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberF5197
License Number StateTX

VIII. Authorized Official

Name: DR. TARIQ MAHMOOD
Title or Position: CEO
Credential: MD
Phone: 830-334-4016