Provider Demographics
NPI:1679518542
Name:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:BYROM
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:254-248-6301
Mailing Address - Street 1:402 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-1315
Mailing Address - Country:US
Mailing Address - Phone:254-248-6380
Mailing Address - Fax:254-248-6369
Practice Address - Street 1:1507 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528
Practice Address - Country:US
Practice Address - Phone:254-248-6380
Practice Address - Fax:254-865-8605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-17
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001525251E00000X
251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000064100OtherPRIMARY HOME CARE VENDOR
TXKD4576680Medicaid
TX00063680OtherCOMMUNITY BASED ALTERNATI
TXKD4576680Medicaid