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General NPI Number Information
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NPI Number | 1215968748
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Entity Type | Organization
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Legal Business Name | MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 1204 N MOUND ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4027
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Country | US
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Telephone | 936-564-4611
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 N MOUND ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4027
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Country | US
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Telephone | 936-564-4611
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | JANE ANN BRIDGES
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Credential | CPA
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Telephone | 936-568-8525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 000478
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 000478
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 000478
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 000478
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License Number State | TX
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