MEDICARE: COZBY-GERMANY HOSPITAL

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	207P00000X	Emergency Medicine Physician	000138	TX
2	207Q00000X	Family Medicine Physician	L4110	TX
3	367500000X	Certified Registered Nurse Anesthetist	547756	TX
4	367500000X	Certified Registered Nurse Anesthetist	453723	TX
5	282NR1301X	Rural Acute Care Hospital	000138	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215934989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COZBY-GERMANY HOSPITAL

Provider Business Mailing Address
First Line	:	707 NORTH WALDRIP STREET
Second Line	:
City	:	GRAND SALINE
State	:	TX
Zip	:	75140-1555
Country	:	US
Telephone Number	:	903-962-4242
Fax Number	:	903-962-7338

Provider Business Practice Location Address
First Line	:	707 NORTH WALDRIP STREET
Second Line	:
City	:	GRAND SALINE
State	:	TX
Zip	:	75140-1555
Country	:	US
Telephone Number	:	903-962-4242
Fax Number	:	903-962-7338

Authorized Official
Title or Position	:	BOARD MEMBER
Name	:	MR. TOM ELLIOTT
Credential	:
Telephone Number	:	903-962-4242

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/06/2013

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Directions to “COZBY-GERMANY HOSPITAL ” Practice Location

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