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General NPI Number Information
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NPI Number | 1336100429
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Entity Type | Organization
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Legal Business Name | SAN BENITO HEALTHCARE 1, LLC
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 E HWY 77
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City | SAN BENITO
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State | TX
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Zip | 78586-5310
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Country | US
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Telephone | 956-365-5200
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Fax | 956-365-5251
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Provider Business Mailing Address
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Address Line | 400 E HWY 77 P.O. BOX 42
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City | SAN BENITO
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State | TX
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Zip | 78586-5310
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Country | US
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Telephone | 956-365-5200
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Fax | 956-365-5251
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | IGOR KOZLIK
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Credential |
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Telephone | 956-365-5236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 000245
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License Number State | TX
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