Provider Demographics
NPI:1700878014
Name:LAIRD MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:LAIRD MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLZEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-983-4352
Mailing Address - Street 1:1612 S HENDERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-3518
Mailing Address - Country:US
Mailing Address - Phone:903-983-4308
Mailing Address - Fax:903-983-4306
Practice Address - Street 1:1612 S HENDERSON BLVD
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3518
Practice Address - Country:US
Practice Address - Phone:903-983-4308
Practice Address - Fax:903-983-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH0109OtherBLUECROSS BLUE SHIELD
TX5290733OtherUNITED HEALTHCARE
TX85352OtherAMERICAID
TX85352OtherAMERICAID
TX450488Medicare Oscar/Certification
TX=========Medicaid