Provider Demographics
NPI:1679749659
Name:SCOTT AND WHITE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SCOTT AND WHITE MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DIECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-724-2111
Mailing Address - Street 1:2317 WARWICKE CT
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7380
Mailing Address - Country:US
Mailing Address - Phone:254-899-0956
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-0001
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3760282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital