Provider Demographics
NPI:1205839016
Name:HILL COUNTRY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HILL COUNTRY MEMORIAL HOSPITAL
Other - Org Name:HILL COUNTRY MEMORIAL HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTMERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:830-997-1336
Mailing Address - Street 1:PO BOX 835
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-0835
Mailing Address - Country:US
Mailing Address - Phone:830-997-1336
Mailing Address - Fax:830-997-1559
Practice Address - Street 1:808 REUBEN ST.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5405
Practice Address - Country:US
Practice Address - Phone:830-997-1336
Practice Address - Fax:830-997-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007479251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136430903Medicaid
TX457216Medicare ID - Type UnspecifiedPROVIDER NUMBER