Provider Demographics
NPI:1780298547
Name:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-248-3213
Mailing Address - Street 1:1507 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-1024
Mailing Address - Country:US
Mailing Address - Phone:254-865-2166
Mailing Address - Fax:254-248-0626
Practice Address - Street 1:404 AVENUE E
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:TX
Practice Address - Zip Code:76557-3579
Practice Address - Country:US
Practice Address - Phone:254-865-2166
Practice Address - Fax:254-248-0626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-31
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTIN