Organization
DICKERSON MEMORIAL HOSPITAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN TATUM (ADMINISTRATOR)
(281) 447-6800
Entity
Organization
Contact information
Practice address
1001 DICKERSON DR, JASPER, TX 75951-5110
(409) 383-2345
(281) 447-6802
Mailing address
260 N SAM HOUSTON PKWY E, SUITE 220, HOUSTON, TX 77060-2018
(281) 447-6800
(281) 447-6802
Taxonomy
Speciality
Code
Description
License number
State
282NR1301X
Rural Acute Care Hospital
Primary
007235
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HH0400
BCBS PROVIDER ID
TX
Enumeration date
04/10/2007
Last updated
08/22/2020
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