# DICKERSON MEMORIAL HOSPITAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003939232
- **Authorized official:** MR. JOHN TATUM (ADMINISTRATOR)
- **Authorized official phone:** (281) 447-6800

## Contact information

- **Practice address:** 1001 DICKERSON DR, JASPER, TX 75951-5110
- **Practice address phone:** (409) 383-2345
- **Practice address fax:** (281) 447-6802
- **Mailing address:** 260 N SAM HOUSTON PKWY E, SUITE 220, HOUSTON, TX 77060-2018
- **Mailing address phone:** (281) 447-6800
- **Mailing address fax:** (281) 447-6802

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282NR1301X | Rural Acute Care Hospital | 007235 | TX | Yes |

## Other

- **Enumeration date:** 04/10/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | HH0400 | BCBS PROVIDER ID | TX |