1083612121 NPI number — STONEWALL MEMORIAL HOSPITAL

Table of content: (NPI 1083612121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083612121 NPI number — STONEWALL MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STONEWALL MEMORIAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STONEWALL MEMORIAL HOSPITAL DISTRICT
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083612121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
821 N BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASPERMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79502-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-989-3551
Provider Business Mailing Address Fax Number:
940-989-3662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 N BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASPERMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79502-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-989-3551
Provider Business Practice Location Address Fax Number:
940-989-3662
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MOORHEAD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
940-989-3551

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  00G24G , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: D4789 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: J6646 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: H9774 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC0050X , with the licence number: 453986 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: 453986 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 275N00000X , with the licence number: 000666 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 000666 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 45D0600750 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: F0906010 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1649378712 . This is a "NP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 063461001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1538142617 . This is a "PHYSICIAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1972577963 . This is a "PHYSICIAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0209926-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020992601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 451318 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 096502201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 127312001 . This is a "MEDICARE/MEDICAID CROSSOVER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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