Healthcare Provider Details

I. General information

NPI: 1619958691
Provider Name (Legal Business Name): GUADALUPE COUNTY HOSPITAL BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 HOWARD ST
SAN ANTONIO TX
78212-3444
US

IV. Provider business mailing address

1215 E COURT ST
SEGUIN TX
78155-5129
US

V. Phone/Fax

Practice location:
  • Phone: 210-737-5100
  • Fax: 210-737-5157
Mailing address:
  • Phone: 830-410-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number111729
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number117449
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number117449
License Number StateTX

VIII. Authorized Official

Name: PENNY WALLACE
Title or Position: CFO
Credential:
Phone: 830-401-7220