Provider Demographics
NPI:1972628816
Name:WALKER COUNTY HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:WALKER COUNTY HOSPITAL CORPORATION
Other - Org Name:HUNTSVILLE MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-435-3411
Mailing Address - Street 1:110 MEMORIAL HOSPITAL DRIVE
Mailing Address - Street 2:REVENUE CYCLE
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4957
Mailing Address - Country:US
Mailing Address - Phone:936-439-1440
Mailing Address - Fax:936-435-2244
Practice Address - Street 1:125 MEDICAL PARK LN STE C
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4957
Practice Address - Country:US
Practice Address - Phone:936-291-3219
Practice Address - Fax:936-291-7206
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALKER COUNTY HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-20
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107642401Medicaid
673976Medicare ID - Type UnspecifiedMEDICARE