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	261QR1300X	Rural Health Clinic/Center

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	:	1811290588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TM VAN ZANDT HOSPITAL LLC

Provider Business Mailing Address
First Line	:	749 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	:	CFO
Name	:	JOE WHITE
Credential	:
Telephone Number	:	254-697-6591

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	02/28/2011

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Directions to “TM VAN ZANDT HOSPITAL LLC ” Practice Location

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