Healthcare Provider Details

I. General information

NPI: 1083021570
Provider Name (Legal Business Name): CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 TEHUACANA HIGHWAY
MEXIA TX
76667
US

IV. Provider business mailing address

PO BOX 7300
GLEN ROSE TX
76043
US

V. Phone/Fax

Practice location:
  • Phone: 254-562-3867
  • Fax: 254-729-3475
Mailing address:
  • Phone: 254-269-0069
  • Fax: 254-269-0070

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 BYROM
Title or Position: CEO
Credential:
Phone: 254-248-6301