Provider Demographics
NPI:1710942040
Name:SCOTT & WHITE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SCOTT & WHITE MEMORIAL HOSPITAL
Other - Org Name:SCOTT & WHITE INFUSION SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR, CBS
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-215-9719
Mailing Address - Street 1:PO BOX 847789
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7789
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5701 AIRPORT RD # PODM164
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-7092
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTT & WHITE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-19
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No251F00000XAgenciesHome Infusion
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0841450001OtherRR/MEDICARE
TX519136OtherBLUE CROSS DME
TX750421OtherBLUE CROSS
TX0913501-02Medicaid
TX0913501-02Medicaid
TX0841450001Medicare NSC