Provider Demographics
NPI:1578396859
Name:JASPER HOSPITAL DISTRICT
Entity type:Organization
Organization Name:JASPER HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-489-4220
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75710-0878
Mailing Address - Country:US
Mailing Address - Phone:716-389-3279
Mailing Address - Fax:716-639-1382
Practice Address - Street 1:2427 SAM RAYBURN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKELAND
Practice Address - State:TX
Practice Address - Zip Code:75931-6408
Practice Address - Country:US
Practice Address - Phone:409-489-4220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty