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General NPI Number Information
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NPI Number | 1003939232
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Entity Type | Organization
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Legal Business Name | DICKERSON MEMORIAL HOSPITAL, LLC
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1001 DICKERSON DR
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City | JASPER
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State | TX
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Zip | 75951-5110
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Country | US
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Telephone | 409-383-2345
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Fax | 281-447-6802
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Provider Business Mailing Address
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Address Line | 260 N SAM HOUSTON PKWY E SUITE 220
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City | HOUSTON
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State | TX
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Zip | 77060-2018
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Country | US
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Telephone | 281-447-6800
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Fax | 281-447-6802
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOHN TATUM
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Credential |
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Telephone | 281-447-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 007235
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License Number State | TX
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