Specialty Hospital, LLC

Primary specialty

Special HospitalTaxonomy code 284300000X

Legal business name

SPECIALTY HOSPITAL, LLC

Practice address

1000 S Beckham Ave FL 5
Tyler, TX 75701-1908

Phone

(903) 596-3600

NPI assigned

Jan 30, 2018

Organization subpart

Yes

Parent organization

AHS EAST TEXAS HEALTH SYSTEM, LLCAs reported in NPPES

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

Authorized official

Name

Stephen C Petrovich

Title

Evp

Phone

(615) 296-3000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962900472. Details of each certification follow.

• CCN 452051 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 452051

Legal name

UT HEALTH EAST TEXAS SPECIALTY HOSPITAL

Certification status

Terminated Voluntary: merger or closure, Apr 27, 2024

Provider type (POS)

Hospital – Long-term

Participating since

May 1, 1995

Last certification

Dec 29, 2021

Beds

36

Ownership / control type

Private (for profit)

Most recent change of ownership

Mar 1, 2018 (1 total)

Facility address

1000 S Beckham FL 5
Tyler, TX 75701

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

{
    "created_epoch": "1517270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696118400000",
    "number": "1962900472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 SEVEN SPRINGS WAY STE 100",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275697",
            "telephone_number": "615-296-3000",
            "fax_number": "615-296-6227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S BECKHAM AVE FL 5",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011908",
            "telephone_number": "903-596-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY HOSPITAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AHS EAST TEXAS HEALTH SYSTEM, LLC",
        "enumeration_date": "2018-01-30",
        "last_updated": "2023-10-01",
        "certification_date": "2023-10-01",
        "status": "A",
        "authorized_official_last_name": "PETROVICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EVP",
        "authorized_official_telephone_number": "615-296-3000"
    },
    "taxonomies": [
        {
            "code": "284300000X",
            "taxonomy_group": "",
            "desc": "Special Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.