MEDICARE: CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1235528894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY

Provider Business Mailing Address
First Line	:	1950 S LAS VEGAS TRL
Second Line	:
City	:	WHITE SETTLEMENT
State	:	TX
Zip	:	76108-3350
Country	:	US
Telephone Number	:	817-246-4995
Fax Number	:	817-246-1025

Provider Business Practice Location Address
First Line	:	1950 S LAS VEGAS TRL
Second Line	:
City	:	WHITE SETTLEMENT
State	:	TX
Zip	:	76108-3350
Country	:	US
Telephone Number	:	817-246-4995
Fax Number	:	817-246-1025

Authorized Official
Title or Position	:	CEO
Name	:	DAVID K BYROM
Credential	:
Telephone Number	:	254-248-6300

Provider Enumeration Date	:	01/20/2015
Last Update Date	:	07/18/2022

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Directions to “CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY ” Practice Location

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