MEDICARE: MEMORIAL HOSPITAL

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	251G00000X	Community Based Hospice Care Agency	000478	TX

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	:	1932137916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	1204 N MOUND ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75961-4027
Country	:	US
Telephone Number	:	936-564-4611
Fax Number	:

Provider Business Practice Location Address
First Line	:	1204 N MOUND ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75961-4027
Country	:	US
Telephone Number	:	936-564-4611
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	JANE ANN BRIDGES
Credential	:	CPA
Telephone Number	:	936-568-8525

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	01/28/2010

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Directions to “MEMORIAL HOSPITAL ” Practice Location

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