Provider Demographics
NPI:1063267037
Name:MAVERICK COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:MAVERICK COUNTY HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-757-4990
Mailing Address - Street 1:3406 BOB ROGERS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5942
Mailing Address - Country:US
Mailing Address - Phone:830-213-8815
Mailing Address - Fax:830-757-8708
Practice Address - Street 1:2824 N VETERANS BLVD STE A
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6695
Practice Address - Country:US
Practice Address - Phone:830-213-8815
Practice Address - Fax:830-757-8708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAVERICK COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty