Basic Information
| Provider Information | |||||||||
| NPI: | 1801893417 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SMITHVILLE HOSPITAL AUTHORITY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | SMITHVILLE REGIONAL HOSPITAL | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 800 E HIGHWAY 71 | ||||||||
| Address2: | |||||||||
| City: | SMITHVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789571730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122373214 | ||||||||
| FaxNumber: | 5122375768 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 E HIGHWAY 71 | ||||||||
| Address2: | |||||||||
| City: | SMITHVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 789571730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122373214 | ||||||||
| FaxNumber: | 5122375768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2005 | ||||||||
| LastUpdateDate: | 11/12/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HOOPER | ||||||||
| AuthorizedOfficialFirstName: | GRADY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5122373214 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SMITHVILLE HOSPITAL AUTHORITY | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 000385 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 094115502 | 05 | TX | MEDICAID |