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General NPI Number Information
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NPI Number | 1780298547
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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 | 08/31/2020
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Last Update Date | 02/05/2021
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Provider Practice Location Address
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Address Line | 404 AVENUE E
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City | MOODY
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State | TX
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Zip | 76557-3579
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Country | US
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Telephone | 254-865-2166
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Fax | 254-248-0626
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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 | 254-865-2166
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Fax | 254-248-0626
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | KARA MICHELLE COX
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Credential |
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Telephone | 254-248-3213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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