Provider Demographics
NPI:1578534772
Name:STONEWALL MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:STONEWALL MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:DORIS
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-335-4715
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:1000 N. BROADWAY
Mailing Address - City:ASPERMONT
Mailing Address - State:TX
Mailing Address - Zip Code:79502-0567
Mailing Address - Country:US
Mailing Address - Phone:940-989-3526
Mailing Address - Fax:940-989-3606
Practice Address - Street 1:1000 N. BROADWAY
Practice Address - Street 2:
Practice Address - City:ASPERMONT
Practice Address - State:TX
Practice Address - Zip Code:79502
Practice Address - Country:US
Practice Address - Phone:940-989-3526
Practice Address - Fax:940-989-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115319313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001013568Medicaid
TX001013568Medicaid