Provider Demographics
NPI:1225365026
Name:STEPHENS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:STEPHENS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAULSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-559-2241
Mailing Address - Street 1:200 S GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:76424-4702
Mailing Address - Country:US
Mailing Address - Phone:254-559-2241
Mailing Address - Fax:254-559-2242
Practice Address - Street 1:203 S GENEVA ST
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:TX
Practice Address - Zip Code:76424-4701
Practice Address - Country:US
Practice Address - Phone:254-559-2241
Practice Address - Fax:254-559-2242
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHENS MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH0092OtherBCBS
TX119875604Medicaid
TX119875604Medicaid