Provider Demographics
NPI:1700314366
Name:HILL COUNTRY MEMORIAL COMMUNITY SERVICES CORPORATION
Entity Type:Organization
Organization Name:HILL COUNTRY MEMORIAL COMMUNITY SERVICES CORPORATION
Other - Org Name:GO CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WARRINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-990-6631
Mailing Address - Street 1:PO BOX 835
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-0835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1031 S STATE HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4472
Practice Address - Country:US
Practice Address - Phone:830-992-2820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care