Provider Demographics
NPI:1972581940
Name:THE COMMUNITY HOSPITAL OF BRAZOSPORT
Entity type:Organization
Organization Name:THE COMMUNITY HOSPITAL OF BRAZOSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-285-1802
Mailing Address - Street 1:100 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566
Mailing Address - Country:US
Mailing Address - Phone:979-297-4411
Mailing Address - Fax:979-285-1730
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:979-297-4411
Practice Address - Fax:979-285-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000436282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH362SOtherBLUE CROSS SKILLED UNIT
55805OtherAMERICAID
TXHH0471OtherBLUE CROSS
6541150OtherAETNA
TX112671604Medicaid
TX112764902Medicaid
TX021787901Medicaid
TX112671602Medicaid
TXHH362SOtherBLUE CROSS SKILLED UNIT