Provider Demographics
NPI:1437156361
Name:COUNTY OF CLAY
Entity Type:Organization
Organization Name:COUNTY OF CLAY
Other - Org Name:CLAY COUNTY MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-235-1200
Mailing Address - Street 1:310 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365-3346
Mailing Address - Country:US
Mailing Address - Phone:940-538-5621
Mailing Address - Fax:940-235-1215
Practice Address - Street 1:310 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365-3346
Practice Address - Country:US
Practice Address - Phone:940-538-5621
Practice Address - Fax:940-235-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000193282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451362Medicare ID - Type UnspecifiedMEDICARE
TX45Z362Medicare Oscar/Certification