Healthcare Provider Details

I. General information

NPI: 1700834231
Provider Name (Legal Business Name): SMITHVILLE HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 GARWOOD ST
SMITHVILLE TX
78957-1117
US

IV. Provider business mailing address

907 GARWOOD ST
SMITHVILLE TX
78957-1117
US

V. Phone/Fax

Practice location:
  • Phone: 512-237-4606
  • Fax: 512-360-4035
Mailing address:
  • Phone: 512-237-4606
  • Fax: 512-360-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number117081
License Number StateTX

VIII. Authorized Official

Name: MR. DENNIS C. DOLGENER
Title or Position: ADMINISTRATOR
Credential:
Phone: 512-237-4606