NPIMap

Organization Active NPI

Lavaca Hospital District

Doing business as Lavaca Medical Center

  • Emergency Medicine Physician
  • Hallettsville, TX
National Provider Identifier
1245274471
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
LAVACA HOSPITAL DISTRICT
Doing business as
Lavaca Medical Center
Practice address
1400 N Texana St
Hallettsville, TX 77964-2021
Phone
(361) 798-3671
Fax
(361) 798-3128
NPI assigned
Jun 16, 2006
Last updated
Oct 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jack S Bowen
Title
Administrator
Phone
(361) 798-3671

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

1400 N Texana St
Hallettsville, TX 77964-2021

Mailing address

1400 N Texana St
Hallettsville, TX 77964-2021
Phone (361) 798-3671

Other identifiers 1

IdentifierTypeStateIssuer
135233801MedicaidTX

Other names 1

  • Lavaca Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040317001233 TX Part B Supplier - Clinic/Group Practice 1153211750 Receives reassigned benefits from 40 practitioners
Practice locations: Hallettsville, TX

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Lavaca Family Health CL5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1406 N Texana St
Ste D
Hallettsville, TX 77964
Phone (361) 798-1200

Practitioners & affiliated clinicians

Practitioners 52

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 52

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603152000000",
    "number": "1245274471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 N TEXANA ST",
            "city": "HALLETTSVILLE",
            "state": "TX",
            "postal_code": "779642021",
            "telephone_number": "361-798-3671",
            "fax_number": "361-798-3128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N TEXANA ST",
            "city": "HALLETTSVILLE",
            "state": "TX",
            "postal_code": "779642021",
            "telephone_number": "361-798-3671",
            "fax_number": "361-798-3128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAVACA HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A",
        "authorized_official_last_name": "BOWEN",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "361-798-3671"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135233801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lavaca Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hallettsville, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.