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General NPI Number Information
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NPI Number | 1821032780
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Entity Type | Organization
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Legal Business Name | GLEN ROSE MEDICAL FOUNDATION
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1021 HOLDEN ST
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City | GLEN ROSE
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State | TX
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Zip | 76043-4937
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Country | US
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Telephone | 254-897-2215
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Fax | 254-897-1446
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Provider Business Mailing Address
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Address Line | PO BOX 299
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City | GLEN ROSE
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State | TX
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Zip | 76043-0299
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Country | US
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Telephone | 254-897-2215
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Fax | 254-897-1446
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Authorized Official
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Title or Position | CFO
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Name | HAL MAYO
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Credential |
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Telephone | 254-897-2215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 000059
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QC0050X
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Taxonomy Name | Critical Access Hospital Clinic/Center
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License Number | 000059
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 000059
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 281P00000X
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Taxonomy Name | Chronic Disease Hospital
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License Number | 000059
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License Number State | TX
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