Healthcare Provider Details

I. General information

NPI: 1962810465
Provider Name (Legal Business Name): CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 ROGGE LN
AUSTIN TX
78723-3640
US

IV. Provider business mailing address

3509 ROGGE LN
AUSTIN TX
78723-3640
US

V. Phone/Fax

Practice location:
  • Phone: 512-926-2070
  • Fax: 512-926-9570
Mailing address:
  • Phone: 512-926-2070
  • Fax: 512-926-9570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID K BYROM
Title or Position: CEO
Credential:
Phone: 254-248-6301