MEDICARE: WEST WHARTON COUNTY 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	111436	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	:	1750388617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST WHARTON COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	3001 W 4TH AVE
Second Line	:
City	:	CORSICANA
State	:	TX
Zip	:	75110-3913
Country	:	US
Telephone Number	:	903-872-2521
Fax Number	:	903-872-2559

Provider Business Practice Location Address
First Line	:	3001 W 4TH AVE
Second Line	:
City	:	CORSICANA
State	:	TX
Zip	:	75110-3913
Country	:	US
Telephone Number	:	903-872-2521
Fax Number	:	903-872-2559

Authorized Official
Title or Position	:	CFO
Name	:	DAVID H MAK
Credential	:
Telephone Number	:	713-569-7370

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	04/22/2022

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