Provider Demographics
NPI:1124208301
Name:WILSON COUNTY MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WILSON COUNTY MEMORIAL HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-393-1306
Mailing Address - Street 1:499 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114
Mailing Address - Country:US
Mailing Address - Phone:830-393-1300
Mailing Address - Fax:830-393-1301
Practice Address - Street 1:499 10TH ST
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3175
Practice Address - Country:US
Practice Address - Phone:830-393-1300
Practice Address - Fax:830-393-1301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONNALLY MEMORIAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-06
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X
TX45U108282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45U108OtherMEDICARE SWINGBED