Provider Demographics
NPI:1952531824
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:INSURANCE REP
Authorized Official - Prefix:MS
Authorized Official - First Name:TWILA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-248-6204
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:254-865-8251
Mailing Address - Fax:254-248-6306
Practice Address - Street 1:3401 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-1028
Practice Address - Country:US
Practice Address - Phone:254-865-8251
Practice Address - Fax:254-248-6306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty