MEDICARE: CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386078012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY

Provider Business Mailing Address
First Line	:	2713 S COMMERCIAL AVE
Second Line	:
City	:	COLEMAN
State	:	TX
Zip	:	76834-7503
Country	:	US
Telephone Number	:	325-625-4105
Fax Number	:	325-625-3124

Provider Business Practice Location Address
First Line	:	2713 S COMMERCIAL AVE
Second Line	:
City	:	COLEMAN
State	:	TX
Zip	:	76834-7503
Country	:	US
Telephone Number	:	325-625-4105
Fax Number	:	325-625-3124

Authorized Official
Title or Position	:	CEO
Name	:	DAVID BYROM
Credential	:
Telephone Number	:	254-248-6204

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	08/29/2013

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