Provider Demographics
NPI:1700294295
Name:WALKER COUNTY HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:WALKER COUNTY HOSPITAL CORPORATION
Other - Org Name:HUNTSVILLE MEMORIAL MED CLINIC - RIVERSIDE
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:9362-912-5230
Mailing Address - Street 1:100 MEMORIAL HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3638 HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-0464
Practice Address - Country:US
Practice Address - Phone:936-291-3219
Practice Address - Fax:936-291-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health