Provider Demographics
NPI:1700826575
Name:SOMERVELL COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SOMERVELL COUNTY HOSPITAL DISTRICT
Other - Org Name:GLEN ROSE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-897-1425
Mailing Address - Street 1:1021 HOLDEN ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-4937
Mailing Address - Country:US
Mailing Address - Phone:254-897-2215
Mailing Address - Fax:254-897-1446
Practice Address - Street 1:1021 HOLDEN ST
Practice Address - Street 2:
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-4937
Practice Address - Country:US
Practice Address - Phone:254-897-2215
Practice Address - Fax:254-897-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000059282NR1301X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200134272OtherALL MANAGED CARE INS
TXHH0458OtherBLUE CROSS BLUE SHIELD
TX121800003Medicaid
TX121800004Medicaid
TX200134272OtherALL COMMERCIAL INSURANCE
TXHH0458OtherBLUE CROSS BLUE SHIELD