Provider Demographics
NPI:1669480323
Name:KELL WEST REGIONAL HOSPITAL LLC
Entity Type:Organization
Organization Name:KELL WEST REGIONAL HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-692-5888
Mailing Address - Street 1:5420 KELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1610
Mailing Address - Country:US
Mailing Address - Phone:940-692-5888
Mailing Address - Fax:940-692-0915
Practice Address - Street 1:5420 KELL BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1610
Practice Address - Country:US
Practice Address - Phone:940-692-5888
Practice Address - Fax:940-692-0915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006814282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH0966OtherBLUE CROSS
TX168648701Medicaid
TXHH0966OtherBLUE CROSS
TX00846NMedicare ID - Type UnspecifiedER GROUP