MEDICARE: SIGNATURE GULF COAST HOSPITAL LP

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	314000000X	Skilled Nursing Facility	008330	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

General Provider Information

NPI Number	:	1275576431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIGNATURE GULF COAST HOSPITAL LP

Provider Business Mailing Address
First Line	:	PO BOX 848487
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-8487
Country	:	US
Telephone Number	:	979-282-6141
Fax Number	:	979-282-6036

Provider Business Practice Location Address
First Line	:	10141 US 59 RD
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488-7224
Country	:	US
Telephone Number	:	979-282-6141
Fax Number	:	979-282-6036

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS SERVICES
Name	:	MRS. NANCY S MONTELLO
Credential	:
Telephone Number	:	979-282-6141

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	08/04/2008

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