MEDICARE: SOUTH LIMESTONE HOSPITAL DISTRICT

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	4868	TX

General Provider Information

NPI Number	:	1629516109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH LIMESTONE HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	701 MCCLINTIC DR
Second Line	:
City	:	GROESBECK
State	:	TX
Zip	:	76642-2128
Country	:	US
Telephone Number	:	254-729-3281
Fax Number	:	254-729-2689

Provider Business Practice Location Address
First Line	:	601 TERRACE LN
Second Line	:
City	:	MEXIA
State	:	TX
Zip	:	76667-2072
Country	:	US
Telephone Number	:	254-562-5400
Fax Number	:	254-562-9145

Authorized Official
Title or Position	:	CEO
Name	:	MR. LARRY N PRICE
Credential	:
Telephone Number	:	254-729-3281

Provider Enumeration Date	:	02/06/2017
Last Update Date	:	02/06/2017

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Directions to “SOUTH LIMESTONE HOSPITAL DISTRICT ” Practice Location

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