Healthcare Provider Details

I. General information

NPI: 1235528894
Provider Name (Legal Business Name): CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 S LAS VEGAS TRL
WHITE SETTLEMENT TX
76108-3350
US

IV. Provider business mailing address

1950 S LAS VEGAS TRL
WHITE SETTLEMENT TX
76108-3350
US

V. Phone/Fax

Practice location:
  • Phone: 817-246-4995
  • Fax: 817-246-1025
Mailing address:
  • Phone: 817-246-4995
  • Fax: 817-246-1025

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 K BYROM
Title or Position: CEO
Credential:
Phone: 254-248-6300