Provider Demographics
NPI:1679612808
Name:TERRY MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:TERRY MEMORIAL HOSPITAL DISTRICT
Other - Org Name:BRMC HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOME HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:806-637-0063
Mailing Address - Street 1:801 E TAHOKA RD
Mailing Address - Street 2:
Mailing Address - City:BROWNFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79316-3635
Mailing Address - Country:US
Mailing Address - Phone:806-637-0063
Mailing Address - Fax:806-637-1032
Practice Address - Street 1:801 E TAHOKA RD
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:TX
Practice Address - Zip Code:79316-3635
Practice Address - Country:US
Practice Address - Phone:806-637-0063
Practice Address - Fax:806-637-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002205251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXKO6774155Medicaid
TX677415Medicare ID - Type Unspecified