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NPI Code Detail

MEDICARE: SID PETERSON MEMORIAL HOSPITAL

MEDICARE: SID PETERSON 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
1261Q00000XClinic/Center
2282NR1301XRural Acute Care Hospital000406TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2HH0439OTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1790782704
Entity Type Code : Organization
Provider Name (Legal Business Name) : SID PETERSON MEMORIAL HOSPITAL
Provider Business Mailing Address
First Line : 551 HILL COUNTRY DR
Second Line :
City : KERRVILLE
State : TX
Zip : 78028-6085
Country : US
Telephone Number : 830-896-4200
Fax Number : 830-258-7678
Provider Business Practice Location Address
First Line : 551 HILL COUNTRY DR
Second Line :
City : KERRVILLE
State : TX
Zip : 78028-6085
Country : US
Telephone Number : 830-896-4200
Fax Number : 830-258-7678
Authorized Official
Title or Position : CFO
Name : LISA MEDOVICH
Credential :
Telephone Number : 830-258-7632
Provider Enumeration Date : 07/05/2005
Last Update Date : 07/27/2022

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Practice Location Address:
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78028-6085
Practice Phone: 830-258-6516
Practice Fax:
1790610137 — ALISSA N TOLBERT PA-C
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1205833464 — DR. WILLIAM E MORRIS JR. M.D.
Practice Location Address:
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KERRVILLE, TX
78028-6085
Practice Phone: 830-258-7697
Practice Fax:
1841297652 — BRIDGET ROBLEDO MD
Practice Location Address:
575 HILL COUNTRY DR , 2ND FLOOR
KERRVILLE, TX
78028-6085
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Practice Fax: 830-258-7098
1992796239 — SID PETERSON MEMORIAL HOSPITAL
Practice Location Address:
551 HILL COUNTRY DR
KERRVILLE, TX
78028-6085
Practice Phone: 830-896-4200
Practice Fax: 830-258-7678
1629040910 — DR. GREGORY GENE MCKENZIE MD
Practice Location Address:
551 HILL COUNTRY DR
KERRVILLE, TX
78028-6085
Practice Phone: 830-377-5359
Practice Fax: 830-896-7020

Directions to “SID PETERSON MEMORIAL HOSPITAL ” Practice Location

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