MEDICARE: RICE DISTRICT COMMUNITY 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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician
2	367500000X	Certified Registered Nurse Anesthetist
3	207P00000X	Emergency Medicine Physician	000560	TX

General Provider Information

NPI Number	:	1851591416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICE DISTRICT COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	600 S AUSTIN RD
Second Line	:
City	:	EAGLE LAKE
State	:	TX
Zip	:	77434-3202
Country	:	US
Telephone Number	:	979-234-5571
Fax Number	:	979-234-5176

Provider Business Practice Location Address
First Line	:	600 S AUSTIN RD
Second Line	:
City	:	EAGLE LAKE
State	:	TX
Zip	:	77434-3202
Country	:	US
Telephone Number	:	979-234-5571
Fax Number	:	979-234-5176

Authorized Official
Title or Position	:	DPFS
Name	:	MR. NOBLE ANDERSON
Credential	:
Telephone Number	:	979-234-5571

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	06/09/2008

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Directions to “RICE DISTRICT COMMUNITY HOSPITAL ” Practice Location

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