Provider Demographics
NPI:1083609143
Name:BOWIE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BOWIE MEMORIAL HOSPITAL
Other - Org Name:BOWIE MEMORIAL HOSPITAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:940-872-9374
Mailing Address - Street 1:705 E GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230-3135
Mailing Address - Country:US
Mailing Address - Phone:940-872-9371
Mailing Address - Fax:940-872-1561
Practice Address - Street 1:1001 ROCK ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-3733
Practice Address - Country:US
Practice Address - Phone:940-872-9371
Practice Address - Fax:940-872-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001710251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677028Medicare ID - Type Unspecified