Provider Demographics
NPI:1447259627
Name:TYLER COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:TYLER COUNTY HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-283-6579
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-0549
Mailing Address - Country:US
Mailing Address - Phone:409-283-6579
Mailing Address - Fax:409-283-6430
Practice Address - Street 1:1100 W BLUFF ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979
Practice Address - Country:US
Practice Address - Phone:409-283-6444
Practice Address - Fax:409-283-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000569282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136381405Medicaid
TXHH0497OtherBLUE CROSS PROVIDER NO.
TX136381401Medicaid
TX450460Medicare Oscar/Certification
TXCP3120Medicare Oscar/Certification
TX00ES78Medicare PIN