MEDICARE: WALKER COUNTY HOSPITAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1003291915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALKER COUNTY HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	110 MEMORIAL HOSPITAL DR
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-4940
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 HILL AVE
Second Line	:
City	:	COLDSPRING
State	:	TX
Zip	:	77331-5406
Country	:	US
Telephone Number	:	936-439-1450
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	SHANNON BROWN
Credential	:	CFO
Telephone Number	:	93629125230

Provider Enumeration Date	:	07/22/2015
Last Update Date	:	01/29/2016

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