Provider Demographics
NPI:1821025990
Name:SEMINOLE HOSPITAL DISTRICT OF GAINES COUNTY TEXAS
Entity Type:Organization
Organization Name:SEMINOLE HOSPITAL DISTRICT OF GAINES COUNTY TEXAS
Other - Org Name:MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMIO
Authorized Official - Prefix:
Authorized Official - First Name:MAEGEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-758-4735
Mailing Address - Street 1:209 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3447
Mailing Address - Country:US
Mailing Address - Phone:432-758-5811
Mailing Address - Fax:
Practice Address - Street 1:209 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3447
Practice Address - Country:US
Practice Address - Phone:432-758-5811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 261QE0002X
TX00113275N00000X
TX000113282NC0060X
TX219294367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Multi-Specialty
No275N00000XHospital UnitsMedicare Defined Swing Bed UnitGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX023219102Medicaid
TX094121301Medicaid
TX088893501Medicaid
TX094121303Medicaid
TX025243901Medicaid
TXHH0223OtherBLUE CROSS BLUE SHIELF
TX451358Medicare Oscar/Certification
TXHH0223OtherBLUE CROSS BLUE SHIELF
TX45Z358Medicare Oscar/Certification
TX094121301Medicaid
TX088893501Medicaid