Provider Demographics
NPI:1467513044
Name:STEPHENS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:STEPHENS MEMORIAL HOSPITAL
Other - Org Name:STEPHENS COUNTY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:KERNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-559-2241
Mailing Address - Street 1:101 S HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:76424-4711
Mailing Address - Country:US
Mailing Address - Phone:254-559-2241
Mailing Address - Fax:254-559-6536
Practice Address - Street 1:101 S HARTFORD ST
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:TX
Practice Address - Zip Code:76424-4711
Practice Address - Country:US
Practice Address - Phone:254-559-2241
Practice Address - Fax:254-559-6536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center