Provider Demographics
NPI:1831180447
Name:SWISHER MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:SWISHER MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXEC 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 2:539 SE 2ND ST
Mailing Address - City:TULIA
Mailing Address - State:TX
Mailing Address - Zip Code:79088-0808
Mailing Address - Country:US
Mailing Address - Phone:806-995-3581
Mailing Address - Fax:806-995-8283
Practice Address - Street 1:539 SE 2ND ST
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:806-995-3581
Practice Address - Fax:806-995-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000273282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130721708Medicaid
TX130721709Medicaid
TX130721707Medicaid
TX00J85TOtherSMH ER GRP BCBS
TX106384100OtherFIRST CARE
TX0076GNOtherSMH RHC BCBS
TX130721704Medicaid
TXHH0321OtherBC & BS
TX130721703Medicaid
TX130721710Medicaid
TX130721710Medicaid
TX130721707Medicaid
TX130721704Medicaid