Healthcare Provider Details

I. General information

NPI: 1124208301
Provider Name (Legal Business Name): WILSON COUNTY MEMORIAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 10TH ST
FLORESVILLE TX
78114-3175
US

IV. Provider business mailing address

499 10TH STREET
FLORESVILLE TX
78114
US

V. Phone/Fax

Practice location:
  • Phone: 830-393-1300
  • Fax: 830-393-1301
Mailing address:
  • Phone: 830-393-1300
  • Fax: 830-393-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number45U108
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. KYLE KLEIN
Title or Position: CFO
Credential:
Phone: 830-393-1306