Provider Demographics
NPI:1417498585
Name:WILSON COUNTY MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WILSON COUNTY MEMORIAL HOSPITAL DISTRICT
Other - Org Name:CONNALLY MEMORIAL HEALTH CENTERS MAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-393-1306
Mailing Address - Street 1:497 10TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-3179
Mailing Address - Country:US
Mailing Address - Phone:830-393-1300
Mailing Address - Fax:
Practice Address - Street 1:497 10TH ST
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3179
Practice Address - Country:US
Practice Address - Phone:830-393-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673441Medicare Oscar/Certification