Hsmtx Waterton Plaza, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

HSMTX WATERTON PLAZA, LLC

Doing business as

The Waterton Plaza Senior Care

Practice address

2875 Shiloh Rd
Tyler, TX 75703-2936

Phone

(903) 561-1300

Fax

(903) 939-1754

NPI assigned

Dec 5, 2007

Organization subpart

No

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

Authorized official

Name

Charles A Davis

Title

VP Finance

Phone

(713) 934-7800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Waterton Plaza Senior Care Doing business as

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

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266278400000",
    "number": "1982886578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 HOLLISTER ST",
            "address_2": "SUITE 550",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770406137",
            "telephone_number": "713-934-7800",
            "fax_number": "713-895-0064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 SHILOH RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757032936",
            "telephone_number": "903-561-1300",
            "fax_number": "903-939-1754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HSMTX WATERTON PLAZA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2010-02-16",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "713-934-7800"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001017767",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Waterton Plaza Senior Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Tyler, TX
• Providers in Tyler, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2010; 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.