=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689966202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DARROUZETT HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2011
-----------------------------------------------------
Last Update Date | 05/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 WEST TEXAS AVE
-----------------------------------------------------
City | DARROUZETT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79024-0111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-625-0063
-----------------------------------------------------
Fax | 806-625-0064
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 WEST TEXAS AVE
-----------------------------------------------------
City | DARROUZETT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79024-0111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-625-0063
-----------------------------------------------------
Fax | 806-625-0064
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/ADMINISTRATOR
-----------------------------------------------------
Name | MRS. VERA CHARLENE DUKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 806-625-0063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | TX148003
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------