Provider Demographics
NPI:1578588463
Name:SCURRY COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SCURRY COUNTY HOSPITAL DISTRICT
Other - Org Name:COGDELL MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-573-6374
Mailing Address - Street 1:1700 COGDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-6162
Mailing Address - Country:US
Mailing Address - Phone:325-574-7437
Mailing Address - Fax:325-574-7433
Practice Address - Street 1:1700 COGDELL BLVD
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-6162
Practice Address - Country:US
Practice Address - Phone:325-574-7437
Practice Address - Fax:325-574-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000439282N00000X
TX008691282N00000X
TX08691282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136330107Medicaid
45D0949117OtherCLIA #
TX450073Medicare PIN
TX451384Medicare Oscar/Certification
TX450073Medicare Oscar/Certification
TX45Z384Medicare PIN
TX45Z384Medicare Oscar/Certification
45D0949117OtherCLIA #
TX136330102Medicaid
TX136330101Medicaid