=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831299031
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOOD COUNTY HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1322 PALUXY RD SUITE 2
-----------------------------------------------------
City | GRANBURY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76048-5603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-579-1642
-----------------------------------------------------
Fax | 817-579-9926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1322 PALUXY RD SUITE 2
-----------------------------------------------------
City | GRANBURY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76048-5603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-579-1642
-----------------------------------------------------
Fax | 817-579-9926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC MANAGER
-----------------------------------------------------
Name | JILL GRAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-579-1642
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------