Healthcare Provider Details

I. General information

NPI: 1174866735
Provider Name (Legal Business Name): NIX COMMUNITY GENERAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E HACKBERRY ST STE B
PEARSALL TX
78061-4411
US

IV. Provider business mailing address

414 NAVARRO ST STE 600
SAN ANTONIO TX
78205-2541
US

V. Phone/Fax

Practice location:
  • Phone: 830-334-4016
  • Fax:
Mailing address:
  • Phone: 210-271-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JON ELDERS
Title or Position: SECRETARY
Credential:
Phone: 714-788-1249