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General NPI Number Information
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NPI Number | 1710424270
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Entity Type | Organization
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Legal Business Name | CLAY COUNTY MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 412 W SOUTH ST
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City | HENRIETTA
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State | TX
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Zip | 76365-3348
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Country | US
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Telephone | 940-235-3407
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Fax |
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Provider Business Mailing Address
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Address Line | 412 W SOUTH ST
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City | HENRIETTA
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State | TX
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Zip | 76365-3348
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Country | US
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Telephone | 940-235-3407
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LISA SWENSON
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Credential |
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Telephone | 940-235-3410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | TX
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