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General NPI Number Information
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NPI Number | 1689443467
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Entity Type | Organization
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Legal Business Name | LAKE GRANBURY HOSPITAL-BASED PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 12/21/2023
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 1310 PALUXY RD
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City | GRANBURY
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State | TX
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Zip | 76048-5655
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Country | US
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Telephone | 817-573-2273
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 680060
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City | FRANKLIN
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State | TN
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Zip | 37068-0060
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Country | US
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Telephone | 877-848-1457
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Fax | 659-235-6176
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Authorized Official
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Title or Position | SR. DIRECTOR, OPERATIONS
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Name | WENDI KEETON
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Credential |
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Telephone | 877-892-9815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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