Provider Demographics
NPI:1275581852
Name:ROLLING PLAINS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ROLLING PLAINS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-235-1701
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-0690
Mailing Address - Country:US
Mailing Address - Phone:325-235-1701
Mailing Address - Fax:325-235-8705
Practice Address - Street 1:200 E ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-7120
Practice Address - Country:US
Practice Address - Phone:325-235-1701
Practice Address - Fax:325-235-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000471261QA1903X, 275N00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133244703Medicaid
TX133244705Medicaid
TX45U055Medicare Oscar/Certification
TX133244703Medicaid