STONEWALL MEMORIAL HOSPITAL

Provider Demographics

• NPI: 1083612121
• Name: STONEWALL MEMORIAL HOSPITAL
• Entity Type: Organization
• Organization Name: STONEWALL MEMORIAL HOSPITAL
• Other - Org Name: STONEWALL MEMORIAL HOSPITAL DISTRICT
• Other - Org Type: Other Name
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: MICHAEL
• Authorized Official - Last Name: MOORHEAD
• Authorized Official - Phone: 940-989-3551
• Mailing Address - Street 1: 821 N BROADWAY ST
• Mailing Address - City: ASPERMONT
• Mailing Address - State: TX
• Mailing Address - Zip Code: 79502-2029
• Mailing Address - Country: US
• Mailing Address - Phone: 940-989-3551
• Mailing Address - Fax: 940-989-3662
• Practice Address - Street 1: 821 N BROADWAY ST
• Practice Address - City: ASPERMONT
• Practice Address - State: TX
• Practice Address - Zip Code: 79502-2029
• Practice Address - Country: US
• Practice Address - Phone: 940-989-3551
• Practice Address - Fax: 940-989-3662
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-07-12
• Last Update Date: 2024-02-05

Provider Licenses

State	License ID	Taxonomies
TX	00G24G	207P00000X
TX	D4789	207Q00000X
TX	J6646	207Q00000X
TX	H9774	2084P0800X
TX	453986	261QC0050X, 261QR1300X
TX	000666	275N00000X, 282NC0060X
TX	45D0600750	291U00000X
TX	F0906010	363L00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	282NC0060X	Hospitals	General Acute Care Hospital	Critical Access
No	207P00000X	Allopathic & Osteopathic Physicians	Emergency Medicine		Group - Multi-Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	261QC0050X	Ambulatory Health Care Facilities	Clinic/Center	Critical Access Hospital
No	261QR1300X	Ambulatory Health Care Facilities	Clinic/Center	Rural Health
No	275N00000X	Hospital Units	Medicare Defined Swing Bed Unit
No	291U00000X	Laboratories	Clinical Medical Laboratory		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
TX	1649378712	Other	NP
TX	063461001	Medicaid
TX	1538142617	Other	PHYSICIAN
TX	1972577963	Other	PHYSICIAN
TX	0209926-01	Medicaid
TX	020992601	Medicaid
TX	451318	Other	MEDICARE
TX	096502201	Medicaid
TX	127312001	Other	MEDICARE/MEDICAID CROSSOVER
TX	1649378712	Other	NP
TX	063461001	Medicaid
TX	00G24G	Medicare PIN