Basic Information
| Provider Information | |||||||||
| NPI: | 1578534772 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STONEWALL MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 567 | ||||||||
| Address2: | 1000 N. BROADWAY | ||||||||
| City: | ASPERMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 795020567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9409893526 | ||||||||
| FaxNumber: | 9409893606 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 N. BROADWAY | ||||||||
| Address2: | |||||||||
| City: | ASPERMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9409893526 | ||||||||
| FaxNumber: | 9409893606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 05/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | LEDBETTER | ||||||||
| AuthorizedOfficialFirstName: | AMELIA | ||||||||
| AuthorizedOfficialMiddleName: | DORIS | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5733354715 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 115319 | TX | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
ID Information
| ID | Type | State | Issuer | Description | 001013568 | 05 | TX | MEDICAID |