Provider Demographics
NPI:1578502613
Name:SCOTT & WHITE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SCOTT & WHITE MEMORIAL HOSPITAL
Other - Org Name:KINGS'S DAUGHTERS HOSPITAL- SCOTT & WHITE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP,RCO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:PULCZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-215-9502
Mailing Address - Street 1:P.O. BOX 847556
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1814
Practice Address - Country:US
Practice Address - Phone:254-771-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000186282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104290100OtherFIRSTCARE
TX2183618-01Medicaid
TXHH0313OtherBLUE CROSS
TX2183618-02Medicaid
TX2183618-01Medicaid