Provider Demographics
NPI:1215438601
Name:FANNIN COUNTY HOSPITAL AUTORITY
Entity type:Organization
Organization Name:FANNIN COUNTY HOSPITAL AUTORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, QUALITY
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-640-7301
Mailing Address - Street 1:504 LIPSCOMB ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4028
Mailing Address - Country:US
Mailing Address - Phone:903-583-8585
Mailing Address - Fax:903-640-7600
Practice Address - Street 1:580 DESHONG DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9318
Practice Address - Country:US
Practice Address - Phone:903-706-5035
Practice Address - Fax:903-706-5036
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FANNIN COUNTY HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1OtherNONE