Healthcare Provider Details

I. General information

NPI: 1699113787
Provider Name (Legal Business Name): SCOTT AND WHITE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S W S YOUNG DR 101B
KILLEEN TX
76543-5317
US

IV. Provider business mailing address

2201 S W S YOUNG DR 101B
KILLEEN TX
76543-5317
US

V. Phone/Fax

Practice location:
  • Phone: 254-501-6479
  • Fax:
Mailing address:
  • Phone: 254-501-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERRY PERRY
Title or Position: DIRECTOR OF DIALYSIS
Credential: RN
Phone: 254-935-5835