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General NPI Number Information
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NPI Number | 1013910868
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Entity Type | Organization
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Legal Business Name | GCMC OF WHARTON COUNTY TEXAS, LLC
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 10141 US 59 RD
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City | WHARTON
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State | TX
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Zip | 77488-7224
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Country | US
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Telephone | 979-282-6141
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Fax | 979-282-6036
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Provider Business Mailing Address
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Address Line | PO BOX 4869, DEPT 407A
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City | HOUSTON
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State | TX
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Zip | 77210-4869
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Country | US
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Telephone | 480-650-7534
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Fax | 480-219-5572
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Authorized Official
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Title or Position | CIO
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Name | MR. KEVIN D CRANDALL
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Credential |
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Telephone | 480-650-7534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 008330
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 100142
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License Number State | TX
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