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General NPI Number Information
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NPI Number | 1740301209
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Entity Type | Organization
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Legal Business Name | FANNIN COUNTY HOSPITAL AUTHORITY
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 1321 W KENTUCKY AVE
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City | PAMPA
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State | TX
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Zip | 79065-4142
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Country | US
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Telephone | 806-669-2551
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Fax |
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Provider Business Mailing Address
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Address Line | 504 LIPSCOMB ST
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City | BONHAM
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State | TX
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Zip | 75418-4028
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BOARD PRESIDENT
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Name | CLARK SANDERSON
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Credential |
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Telephone | 903-583-1854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 118172
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License Number State | TX
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