Provider Demographics
NPI:1417157637
Name:HUNTSVILLE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HUNTSVILLE MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:936-435-2200
Mailing Address - Street 1:PO BOX 4001
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77342-4001
Mailing Address - Country:US
Mailing Address - Phone:936-435-2200
Mailing Address - Fax:936-435-2223
Practice Address - Street 1:110 MEMORIAL HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4940
Practice Address - Country:US
Practice Address - Phone:936-435-2200
Practice Address - Fax:936-435-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41154261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health