MEDICARE: TM VAN ZANDT HOSPITAL LLC

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	275N00000X	Medicare Defined Swing Bed Hospital Unit	000138	TX

General Provider Information

NPI Number	:	1306156575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TM VAN ZANDT HOSPITAL LLC

Provider Business Mailing Address
First Line	:	707 N WALDRIP ST
Second Line	:
City	:	GRAND SALINE
State	:	TX
Zip	:	75140-1555
Country	:	US
Telephone Number	:	254-697-6591
Fax Number	:	254-697-8326

Provider Business Practice Location Address
First Line	:	707 N WALDRIP ST
Second Line	:
City	:	GRAND SALINE
State	:	TX
Zip	:	75140-1555
Country	:	US
Telephone Number	:	254-697-6591
Fax Number	:	254-697-8326

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TARIQ MAHMOOD
Credential	:	M.D.
Telephone Number	:	254-697-6591

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	11/10/2010

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Directions to “TM VAN ZANDT HOSPITAL LLC ” Practice Location

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