1689650616 NPI number — MEMORIAL HOSPITAL OF POLK COUNTY

Table of content: (NPI 1689650616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689650616 NPI number — MEMORIAL HOSPITAL OF POLK COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL HOSPITAL OF POLK COUNTY
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:
CHI ST. LUKE'S HEATH MEMORIAL LIVINGSTON
Provider Other Organization Name Type Code:
3
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:
1689650616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1257
Provider Second Line Business Mailing Address:
MEMOIRAL MEDICAL CENTER LIVINGSTON
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77351-0022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-327-4381
Provider Business Mailing Address Fax Number:
936-327-8702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 HIGHWAY 59 BYPASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-327-4381
Provider Business Practice Location Address Fax Number:
936-327-8702
Provider Enumeration Date:
12/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GLASS
Authorized Official First Name:
MEGAN
Authorized Official Middle Name:
Authorized Official Title or Position:
REIMBURSEMENT ANALYST
Authorized Official Telephone Number:
936-639-7661

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  000466 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NR1301X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112697102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com