Provider Demographics
NPI:1407624323
Name:STONEWALL MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:STONEWALL MEMORIAL HOSPITAL
Other - Org Name:STONEWALL COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-989-3551
Mailing Address - Street 1:821 N BROADWAY ST
Mailing Address - Street 2:
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 - Street 2:
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?:Yes
Parent Organization LBN:STONEWALL MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-20
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport