NPIMap

Organization Active NPI

Lake Granbury Hospital-Based Professional Services

  • Emergency Medicine Physician
  • Granbury, TX
National Provider Identifier
1689443467
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
LAKE GRANBURY HOSPITAL-BASED PROFESSIONAL SERVICES
Practice address
1310 Paluxy Rd
Granbury, TX 76048-5655
Phone
(817) 573-2273
NPI assigned
Dec 21, 2023
Last updated
Jan 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Authorized official

Name
Wendi Keeton
Title
Sr. Director, Operations
Phone
(877) 892-9815

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Certified Registered Nurse Anesthetist 367500000X
Anesthesiology Physician 207L00000X
Critical Care Medicine (Anesthesiology) Physician 207LC0200X
Emergency Medicine Physician 207P00000X Primary
Hospitalist Physician 208M00000X

Addresses

Primary practice location

1310 Paluxy Rd
Granbury, TX 76048-5655

Mailing address

PO Box 680060
Franklin, TN 37068-0060
Phone (877) 848-1457

Other practice location 1

3201 W State Highway 22
Corsicana, TX 75110-2450
Phone (877) 848-1457

Other practice location 2

5309 E US Highway 377
Granbury, TX 76049-1275
Phone (877) 848-1457

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240326003607 TX Part B Supplier - Clinic/Group Practice 3971940966 Receives reassigned benefits from 123 practitioners
Practice locations: Granbury, TX; Corsicana, TX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 123

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 123

NPI Registry JSON

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

{
    "created_epoch": "1703116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737331200000",
    "number": "1689443467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 680060",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370680060",
            "telephone_number": "877-848-1457",
            "fax_number": "659-235-6176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 PALUXY RD",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760485655",
            "telephone_number": "817-573-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3201 W State Highway 22",
            "address_purpose": "LOCATION",
            "city": "Corsicana",
            "state": "TX",
            "postal_code": "751102450",
            "country_code": "US",
            "telephone_number": "877-848-1457",
            "fax_number": "659-235-6176",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5309 E US Highway 377",
            "address_purpose": "LOCATION",
            "city": "Granbury",
            "state": "TX",
            "postal_code": "760491275",
            "country_code": "US",
            "telephone_number": "877-848-1457",
            "fax_number": "659-235-6176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE GRANBURY HOSPITAL-BASED PROFESSIONAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-21",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A",
        "authorized_official_last_name": "KEETON",
        "authorized_official_first_name": "WENDI",
        "authorized_official_title_or_position": "SR. DIRECTOR, OPERATIONS",
        "authorized_official_telephone_number": "877-892-9815"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granbury, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; 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.