Healthcare Provider Details

I. General information

NPI: 1639292964
Provider Name (Legal Business Name): GLEN ROSE MEDICAL FOUNDATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 HOLDEN
GLEN ROSE TX
76043-2099
US

IV. Provider business mailing address

PO BOX 2099
GLEN ROSE TX
76043-2099
US

V. Phone/Fax

Practice location:
  • Phone: 254-897-2215
  • Fax: 254-897-1446
Mailing address:
  • Phone: 254-897-2215
  • Fax: 254-897-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number000059
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number000059
License Number StateTX

VIII. Authorized Official

Name: GARY MARKS
Title or Position: CEO
Credential: CEO
Phone: 254-897-2215