Healthcare Provider Details

I. General information

NPI: 1821422551
Provider Name (Legal Business Name): DEWITT MEDICAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 N RIEDEL ST
YORKTOWN TX
78164-1810
US

IV. Provider business mailing address

508 N RIEDEL ST
YORKTOWN TX
78164-1810
US

V. Phone/Fax

Practice location:
  • Phone: 361-564-9230
  • Fax:
Mailing address:
  • Phone: 361-564-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: GREG S PRITCHETT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 361-275-6191