Provider Demographics
NPI:1962735175
Name:DEWITT MEDICAL DISTRICT
Entity type:Organization
Organization Name:DEWITT MEDICAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-275-6191
Mailing Address - Street 1:2550 N ESPLANADE ST
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-4736
Mailing Address - Country:US
Mailing Address - Phone:361-275-6191
Mailing Address - Fax:361-275-3999
Practice Address - Street 1:104 REX KERWIN CT
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2630
Practice Address - Country:US
Practice Address - Phone:512-251-3915
Practice Address - Fax:512-291-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129310313M00000X
314000000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001026670Medicaid
TX361769801Medicaid
TX5570Medicaid
TX001017662Medicaid
TX001017662Medicaid
TX5570Medicaid