1679501365 NPI number — SHERMAN/GRAYSON HOSPITAL LLC

Table of content: (NPI 1679501365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679501365 NPI number — SHERMAN/GRAYSON HOSPITAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERMAN/GRAYSON HOSPITAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
D/B/A WORKMED GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679501365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 W HOUSTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75090-5909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-891-7000
Provider Business Mailing Address Fax Number:
903-813-1479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N HIGHLAND
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-870-4611
Provider Business Practice Location Address Fax Number:
903-891-2030
Provider Enumeration Date:
06/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REYNOLDS
Authorized Official First Name:
VANCE
Authorized Official Middle Name:
VERNON
Authorized Official Title or Position:
PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
903-870-4591

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 376827601 . This is a "WORK COMP PROV #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".