Healthcare Provider Details

I. General information

NPI: 1083609143
Provider Name (Legal Business Name): BOWIE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 ROCK ST
BOWIE TX
76230-3733
US

IV. Provider business mailing address

705 E GREENWOOD AVE
BOWIE TX
76230-3135
US

V. Phone/Fax

Practice location:
  • Phone: 940-872-9371
  • Fax: 940-872-1561
Mailing address:
  • Phone: 940-872-9371
  • Fax: 940-872-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number001710
License Number StateTX

VIII. Authorized Official

Name: MS. KIMBERLY A COOPER
Title or Position: CONTROLLER
Credential: MBA
Phone: 940-872-9374