NPIMap

Organization Active NPI

Memorial Hospital San Augustine

  • Specialist
  • San Augustine, TX
National Provider Identifier
1326095696
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
K3986 Issued in TX
Legal business name
MEMORIAL HOSPITAL SAN AUGUSTINE
Practice address
511 E Hospital St
San Augustine, TX 75972-2121
Phone
(936) 631-3474
Fax
(936) 631-3475
NPI assigned
May 30, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Fonda R Sullivan
Title
Insurance Supervisor
Phone
(936) 631-3474

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X G8896 TX
Specialist 174400000X L9581 TX
Specialist 174400000X G5444 TX
Specialist 174400000X K3986 TX Primary
Specialist 174400000X F1233 TX

Addresses

Primary practice location

511 E Hospital St
San Augustine, TX 75972-2121

Mailing address

511 E Hospital St
San Augustine, TX 75972-2121
Phone (936) 631-3474

National Provider Directory

National Provider Directory
Tax ID family
Mmcsa Emergency Physici2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1326095696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 E HOSPITAL ST",
            "city": "SAN AUGUSTINE",
            "state": "TX",
            "postal_code": "759722121",
            "telephone_number": "936-631-3474",
            "fax_number": "936-631-3475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 E HOSPITAL ST",
            "city": "SAN AUGUSTINE",
            "state": "TX",
            "postal_code": "759722121",
            "telephone_number": "936-631-3474",
            "fax_number": "936-631-3475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL SAN AUGUSTINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "FONDA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "INSURANCE SUPERVISOR",
        "authorized_official_telephone_number": "936-631-3474"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "G8896",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "L9581",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "G5444",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "K3986",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "F1233",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Augustine, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.