MEDICARE: JOURDANTON HOSPITAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	000334	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	178476300	OTHER	DEPT OF LABOR
2	121780403	OTHER	CHILDRENS SPECIAL NEEDS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	620010	OTHER	FIRST HEALTH
6	450165	OTHER	AETNA
7	HH0154	OTHER	BCBS

General Provider Information

NPI Number	:	1184695785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURDANTON HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 847974
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7974
Country	:	US
Telephone Number	:	830-769-3515
Fax Number	:	830-769-5264

Provider Business Practice Location Address
First Line	:	1905 HIGHWAY 97 E
Second Line	:
City	:	JOURDANTON
State	:	TX
Zip	:	78026-1504
Country	:	US
Telephone Number	:	830-769-3515
Fax Number	:	830-769-5264

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	LAURIE J HOLTSFORD
Credential	:
Telephone Number	:	615-465-7466

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	01/30/2017

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Directions to “JOURDANTON HOSPITAL CORPORATION ” Practice Location

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