Provider Demographics
NPI:1790729861
Name:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Other - Org Name:CORYELL MEMORIAL HEALTHCARE SYSTEM SWINGBED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:TWILA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-248-6204
Mailing Address - Street 1:1507 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-1024
Mailing Address - Country:US
Mailing Address - Phone:254-248-6204
Mailing Address - Fax:254-248-6306
Practice Address - Street 1:1507 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-1024
Practice Address - Country:US
Practice Address - Phone:254-248-6204
Practice Address - Fax:254-248-6306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45Z379Medicare PIN
TX45U239Medicare ID - Type Unspecified