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NPI Code Detail

MEDICARE: LAIRD MEMORIAL HOSPITAL

MEDICARE: LAIRD MEMORIAL HOSPITAL
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
1282N00000XGeneral Acute Care Hospital31TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1HH0109OTHERTXBLUECROSS BLUE SHIELD
25290733OTHERTXUNITED HEALTHCARE
385352OTHERTXAMERICAID

General Provider Information

NPI Number : 1700878014
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAIRD MEMORIAL HOSPITAL
Provider Business Mailing Address
First Line : 1612 S HENDERSON BLVD
Second Line :
City : KILGORE
State : TX
Zip : 75662-3518
Country : US
Telephone Number : 903-983-4308
Fax Number : 903-983-4306
Provider Business Practice Location Address
First Line : 1612 S HENDERSON BLVD
Second Line :
City : KILGORE
State : TX
Zip : 75662-3518
Country : US
Telephone Number : 903-983-4308
Fax Number : 903-983-4306
Authorized Official
Title or Position : CEO/PRESIDENT
Name : BOB ELLZEY
Credential :
Telephone Number : 903-983-4352
Provider Enumeration Date : 08/22/2005
Last Update Date : 08/22/2020

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1407089386 — ALLEGIANCE SPECIALTY HOSPITAL OF KILGORE
Practice Location Address:
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1093319006 — TRACEY LYNN BRUNER FNP
Practice Location Address:
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Directions to “LAIRD MEMORIAL HOSPITAL ” Practice Location

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