Healthcare Provider Details

I. General information

NPI: 1104233592
Provider Name (Legal Business Name): CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W YEAGUA ST
GROESBECK TX
76642-3529
US

IV. Provider business mailing address

1025 W YEAGUA ST
GROESBECK TX
76642-3529
US

V. Phone/Fax

Practice location:
  • Phone: 254-729-3366
  • Fax: 254-729-3475
Mailing address:
  • Phone: 254-729-3366
  • Fax: 254-729-3475

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: 254-248-6300