Healthcare Provider Details

I. General information

NPI: 1184059669
Provider Name (Legal Business Name): CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E PIERSON ST
HAMILTON TX
76531-2358
US

IV. Provider business mailing address

910 E PIERSON ST
HAMILTON TX
76531-2358
US

V. Phone/Fax

Practice location:
  • Phone: 254-386-8113
  • Fax: 254-386-8832
Mailing address:
  • Phone: 254-386-8113
  • Fax: 254-386-8832

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: DAVID BYROM
Title or Position: CEO
Credential:
Phone: 254-248-6204