MEDICARE: DIMMIT REGIONAL 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	207V00000X	Obstetrics & Gynecology Physician	N7201	TX
2	208C00000X	Colon & Rectal Surgery Physician	J7667	TX
3	208600000X	Surgery Physician	J7667	TX

General Provider Information

NPI Number	:	1629351390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIMMIT REGIONAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 1016
Second Line	:
City	:	CARRIZO SPRINGS
State	:	TX
Zip	:	78834-7016
Country	:	US
Telephone Number	:	830-876-2424
Fax Number	:	830-876-5774

Provider Business Practice Location Address
First Line	:	706 HOSPITAL DR
Second Line	:
City	:	CARRIZO SPRINGS
State	:	TX
Zip	:	78834-3836
Country	:	US
Telephone Number	:	830-876-2424
Fax Number	:	830-876-5774

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. ERNEST FLORES JR.
Credential	:
Telephone Number	:	830-876-2424

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/22/2011

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Practice Location Address:

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Practice Location Address:

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Practice Location Address:

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1316283476 — CANE GRASS EMERGENCY PHYSICIANS PLLC
Practice Location Address:

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Practice Fax:

Directions to “DIMMIT REGIONAL HOSPITAL ” Practice Location

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