=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396886263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN JACINTO METHODIST HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 08/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 JAMES BOWIE DR
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77520-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-420-8600
-----------------------------------------------------
Fax | 281-420-8852
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4401 GARTH RD
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77521-2122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-420-8600
-----------------------------------------------------
Fax | 281-420-8852
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR. VICE PRESIDENT
-----------------------------------------------------
Name | MR. BRET THOMAS CURRAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-667-6022
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------