Provider Demographics
NPI:1811954159
Name:SWISHER MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:SWISHER MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOULOVATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-995-8201
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:200 N AUSTIN
Mailing Address - City:TULIA
Mailing Address - State:TX
Mailing Address - Zip Code:79088-0808
Mailing Address - Country:US
Mailing Address - Phone:806-995-3756
Mailing Address - Fax:806-995-3782
Practice Address - Street 1:200 N AUSTIN
Practice Address - Street 2:
Practice Address - City:TULIA
Practice Address - State:TX
Practice Address - Zip Code:79088-0808
Practice Address - Country:US
Practice Address - Phone:806-995-3756
Practice Address - Fax:806-995-3782
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWISHER MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-28
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002791251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130721703Medicaid
TX10638410OtherFIRST CARE
TXHH8026OtherBCBS
TX10638410OtherFIRST CARE