Provider Demographics
NPI:1669673455
Name:SWISHER MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SWISHER MEMORIAL HOSPITAL DISTRICT
Other - Org Name:SWINGBED
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOULOVATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-995-8201
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:TULIA
Mailing Address - State:TX
Mailing Address - Zip Code:79088-0808
Mailing Address - Country:US
Mailing Address - Phone:806-995-3581
Mailing Address - Fax:806-995-8283
Practice Address - Street 1:539 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:TULIA
Practice Address - State:TX
Practice Address - Zip Code:79088-0808
Practice Address - Country:US
Practice Address - Phone:806-995-3581
Practice Address - Fax:806-995-8283
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWISHER MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-30
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016037Medicaid
TX45Z349Medicare Oscar/Certification