Basic Information
| Provider Information | |||||||||
| NPI: | 1518900778 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CORYELL HEALTH MEDICAL CLINIC - MILLS COUNTY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 545 | ||||||||
| Address2: | |||||||||
| City: | GOLDTHWAITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768440545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256482263 | ||||||||
| FaxNumber: | 2542486303 | ||||||||
| Practice Location | |||||||||
| Address1: | 1510 HANNAH VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | GOLDTHWAITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768442533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256482263 | ||||||||
| FaxNumber: | 2542486303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COX | ||||||||
| AuthorizedOfficialFirstName: | KARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2548658251 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.