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NPI Code Detail

MEDICARE: COLLEGE STATION HOSPITAL LP

MEDICARE: COLLEGE STATION 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
1207Q00000XFamily Medicine Physician
2261QA1903XAmbulatory Surgical Clinic/Center
3282N00000XGeneral Acute Care Hospital000071TX

Other Identifiers

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

General Provider Information

NPI Number : 1467403477
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLLEGE STATION HOSPITAL LP
Provider Business Mailing Address
First Line : PO BOX 848526
Second Line :
City : DALLAS
State : TX
Zip : 75284-8526
Country : US
Telephone Number : 979-764-5100
Fax Number : 979-696-7373
Provider Business Practice Location Address
First Line : 1604 ROCK PRAIRIE RD
Second Line :
City : COLLEGE STATION
State : TX
Zip : 77845-8345
Country : US
Telephone Number : 979-764-5100
Fax Number : 979-696-7373
Authorized Official
Title or Position : DIRECTOR/DELEGATED OFFICIAL
Name : PAULA M LALOR
Credential :
Telephone Number : 615-925-4565
Provider Enumeration Date : 05/15/2006
Last Update Date : 09/13/2017

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1275569469 — RANDY A SCHEMIDT MD
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1134158611 — SCOTT KIMBALL MD
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Directions to “COLLEGE STATION HOSPITAL LP ” Practice Location

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