Healthcare Provider Details

I. General information

NPI: 1073579942
Provider Name (Legal Business Name): PREFERRED HOSPITAL LEASING VAN HORN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EISENHOWER-FM 2185
VAN HORN TX
79855-0609
US

IV. Provider business mailing address

EISENHOWER-FM 2185 P.O. BOX 609
VAN HORN TX
79855
US

V. Phone/Fax

Practice location:
  • Phone: 432-283-2760
  • Fax: 432-283-2581
Mailing address:
  • Phone: 432-283-2760
  • Fax: 432-283-2581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: DONALD FREEMAN
Title or Position: PRESIDENT
Credential:
Phone: 405-878-0202