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	261Q00000X	Clinic/Center
2	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1518900778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY

Provider Business Mailing Address
First Line	:	1507 W MAIN ST
Second Line	:
City	:	GATESVILLE
State	:	TX
Zip	:	76528-1024
Country	:	US
Telephone Number	:	254-865-2166
Fax Number	:	254-248-6306

Provider Business Practice Location Address
First Line	:	1510 HANNAH VALLEY RD
Second Line	:
City	:	GOLDTHWAITE
State	:	TX
Zip	:	76844-2533
Country	:	US
Telephone Number	:	325-648-2263
Fax Number	:	254-248-6303

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	KARA COX
Credential	:
Telephone Number	:	254-865-8251

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	11/15/2023

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1982694394 — DR. MELANIE CARYNE BARTEK O. D.
Practice Location Address:

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1366488678 — DR. DEBBIE CRAWFORD DO
Practice Location Address:

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Directions to “CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY ” Practice Location

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