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General NPI Number Information
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NPI Number | 1578396859
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Entity Type | Organization
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Legal Business Name | JASPER HOSPITAL DISTRICT
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Dates
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Enumeration Date | 08/22/2024
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 2427 SAM RAYBURN PKWY
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City | BROOKELAND
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State | TX
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Zip | 75931-6408
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Country | US
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Telephone | 409-489-4220
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 878
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City | TYLER
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State | TX
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Zip | 75710-0878
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Country | US
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Telephone | 716-389-3279
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Fax | 716-639-1382
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | RICHARD D PHAM
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Credential | MD
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Telephone | 409-489-4220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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