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General NPI Number Information
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NPI Number | 1366932592
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Entity Type | Organization
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Legal Business Name | CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 2001 FOREST RIDGE DR
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City | BEDFORD
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State | TX
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Zip | 76021-5712
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Country | US
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Telephone | 817-571-6804
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Fax |
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Provider Business Mailing Address
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Address Line | 1507 W MAIN ST
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City | GATESVILLE
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State | TX
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Zip | 76528-1024
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Country | US
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Telephone | 254-248-6245
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID BYROM
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Credential |
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Telephone | 254-248-6245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | TX
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