Provider Demographics
NPI:1063600724
Name:SHELBY HOSPITAL L.L.C.
Entity type:Organization
Organization Name:SHELBY HOSPITAL L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-541-3009
Mailing Address - Street 1:806 N CROCKETT AVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:TX
Mailing Address - Zip Code:76520-2599
Mailing Address - Country:US
Mailing Address - Phone:254-541-3009
Mailing Address - Fax:210-568-4384
Practice Address - Street 1:602 HURST ST
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-3414
Practice Address - Country:US
Practice Address - Phone:254-541-3009
Practice Address - Fax:210-568-4384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
450839Medicare Oscar/Certification