NPIMap

Organization Active NPI

San Benito Healthcare 1, LLC

  • General Acute Care Hospital
  • San Benito, TX
National Provider Identifier
1336100429
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
000245 Issued in TX
Legal business name
SAN BENITO HEALTHCARE 1, LLC
Practice address
400 E Hwy 77
San Benito, TX 78586-5310
Phone
(956) 365-5200
Fax
(956) 365-5251
NPI assigned
Mar 29, 2006
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
Igor Kozlik
Title
Chief Executive Officer
Phone
(956) 365-5236

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 000245 TX Primary

Addresses

Primary practice location

400 E Hwy 77
San Benito, TX 78586-5310

Mailing address

400 E Hwy 77
P.O. Box 42
San Benito, TX 78586-5310
Phone (956) 365-5200

Other names 1

  • Dolly Vinsant Memorial Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Hospital certification: CCN 450047

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
DOLLY VINSANT MEMORIAL HOSPITAL
Certification status
Terminated Involuntary: failure to meet agreement, Oct 16, 2007
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 15, 2002
Beds
81
Ownership / control type
Private (for profit)
Facility address
400 East Hwy 77
San Benito, TX 78586

National Provider Directory

National Provider Directory

Locations

400 E US Highway 77
San Benito, TX 78586
Phone (956) 365-5402

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336100429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E HWY 77",
            "address_2": "P.O. BOX 42",
            "city": "SAN BENITO",
            "state": "TX",
            "postal_code": "785865310",
            "telephone_number": "956-365-5200",
            "fax_number": "956-365-5251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E HWY 77",
            "city": "SAN BENITO",
            "state": "TX",
            "postal_code": "785865310",
            "telephone_number": "956-365-5200",
            "fax_number": "956-365-5251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN BENITO HEALTHCARE 1, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOZLIK",
        "authorized_official_first_name": "IGOR",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "956-365-5236"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TX",
            "license": "000245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dolly Vinsant Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Benito, TX

Sources for this page

Verify at the official NPI Registry.