Provider Demographics
NPI:1609932086
Name:CLAY COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CLAY COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-538-5621
Mailing Address - Street 1:310 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365-3346
Mailing Address - Country:US
Mailing Address - Phone:940-538-5621
Mailing Address - Fax:940-538-2205
Practice Address - Street 1:310 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365-3346
Practice Address - Country:US
Practice Address - Phone:940-538-5621
Practice Address - Fax:940-538-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0041AXOtherBLUE CROSS BLUE SHIELD
TX0041AXMedicare ID - Type Unspecified