Provider Demographics
NPI:1417063256
Name:HUGULEY MEMORIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:HUGULEY MEMORIAL MEDICAL CENTER
Other - Org Name:HUGULEY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO / VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-551-2704
Mailing Address - Street 1:777 S BURLESON BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4904
Mailing Address - Country:US
Mailing Address - Phone:817-426-2200
Mailing Address - Fax:817-447-7100
Practice Address - Street 1:777 S BURLESON BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4904
Practice Address - Country:US
Practice Address - Phone:817-426-2200
Practice Address - Fax:817-447-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000476251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457575OtherUNITED HEALTHCARE
TX10009901OtherAMERIGROUP TEXAS MCD
TX457575OtherSTERLING LIFE MCR
TX23672101Medicaid
TXHH9081OtherBLUE CROSS BLUE SHIELD
TX2224746OtherAETNA
TX2224746OtherAETNA