Provider Demographics
NPI:1912342999
Name:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Other - Org Name:HICO NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:BYROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-248-6301
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:HICO
Mailing Address - State:TX
Mailing Address - Zip Code:76457-0617
Mailing Address - Country:US
Mailing Address - Phone:254-796-2111
Mailing Address - Fax:254-796-2728
Practice Address - Street 1:712 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:HICO
Practice Address - State:TX
Practice Address - Zip Code:76457
Practice Address - Country:US
Practice Address - Phone:254-796-2111
Practice Address - Fax:254-796-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004739OtherFACID
TX004739OtherFACID