Provider Demographics
NPI:1447215645
Name:SCOTT & WHITE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SCOTT & WHITE MEMORIAL HOSPITAL
Other - Org Name:BAYLOR SCOTT & WHITE HOSPICE - TEMPLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTAKEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-724-2111
Mailing Address - Street 1:PO BOX 847788
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7788
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:5701 AIRPORT RD
Practice Address - Street 2:POD M 195
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-7048
Practice Address - Country:US
Practice Address - Phone:254-724-4090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH044COtherBLUE CROSS
TX001001129Medicaid
TX451691Medicare Oscar/Certification