Provider Demographics
NPI:1285624676
Name:DIMMIT REGIONAL HOSPITAL DISTRICT
Entity type:Organization
Organization Name:DIMMIT REGIONAL HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:SR
Authorized Official - Credentials:RN/BSN
Authorized Official - Phone:830-876-2424
Mailing Address - Street 1:707 HOSPITAL DRIVE
Mailing Address - Street 2:PO BOX 1016
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834
Mailing Address - Country:US
Mailing Address - Phone:830-876-2424
Mailing Address - Fax:830-876-3099
Practice Address - Street 1:707 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:CARRIZO SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78834
Practice Address - Country:US
Practice Address - Phone:830-876-2424
Practice Address - Fax:830-876-3099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIMMIT REGIONAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-26
Last Update Date:2011-02-16
Deactivation Date:2011-02-10
Deactivation Code:
Reactivation Date:2011-02-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX023764601Medicaid
TX457760Medicare ID - Type Unspecified