Provider Demographics
NPI:1730480393
Name:SCOTT & WHITE HOSPITAL - MARBLE FALLS
Entity Type:Organization
Organization Name:SCOTT & WHITE HOSPITAL - MARBLE FALLS
Other - Org Name:BAYLOR SCOTT & WHITE CLINIC - KINGSLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-201-8679
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4339
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:105 FM 2342
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:TX
Practice Address - Zip Code:78639-6010
Practice Address - Country:US
Practice Address - Phone:325-388-3515
Practice Address - Fax:325-388-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100090261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287274901Medicaid
TX0042WFOtherBCBS
TX287274902OtherTHSTEPS
TX458686Medicare Oscar/Certification