=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053581397
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIGNATURE PAMPA HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2008
-----------------------------------------------------
Last Update Date | 03/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ONE MEDICAL PLAZA
-----------------------------------------------------
City | PAMPA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79065-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-663-5600
-----------------------------------------------------
Fax | 806-663-5655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ONE MEDICAL PLAZA
-----------------------------------------------------
City | PAMPA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79065-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-663-5600
-----------------------------------------------------
Fax | 806-663-5655
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING SUPERVISOR
-----------------------------------------------------
Name | MRS. JULIE L SAIZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 806-663-5534
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number | 008329
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------