Provider Demographics
NPI:1518900778
Name:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Other - Org Name:CORYELL HEALTH MEDICAL CLINIC - MILLS COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-865-8251
Mailing Address - Street 1:1507 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-1024
Mailing Address - Country:US
Mailing Address - Phone:254-865-2166
Mailing Address - Fax:254-248-6306
Practice Address - Street 1:1510 HANNAH VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844-2533
Practice Address - Country:US
Practice Address - Phone:325-648-2263
Practice Address - Fax:254-248-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458530Medicare ID - Type Unspecified
458530Medicare PIN