Coryell County Memorial Hospital Authority

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY

Practice address

1150 E Loop 304
Crockett, TX 75835-1810

Phone

(936) 544-2051

Fax

(936) 544-8961

NPI assigned

Feb 27, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. David K Byrom

Title

Ceo

Phone

(254) 248-6300

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• COMMUNITY CARE CENTER OF CROCKETT Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488153600000",
    "number": "1477093284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 E LOOP 304",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351810",
            "telephone_number": "936-544-2051",
            "fax_number": "936-544-8961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 E LOOP 304",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758351810",
            "telephone_number": "936-544-2051",
            "fax_number": "936-544-8961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-27",
        "last_updated": "2017-02-27",
        "status": "A",
        "authorized_official_last_name": "BYROM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "254-248-6300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COMMUNITY CARE CENTER OF CROCKETT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Makaila Ann Brown, NURSE
• Karisa Corley Burke, M.ED., M.A., LPC
• John Allan Burnett, MD
• Children'S Clinic of Crockett
• Coryell County Memorial Hospital Authority
• Coryell County Memorial Hospital Authority
• Crockett Clinic LLP
• Crockett Counseling Center , LLC
• Crockett Dental Care PLLC
• Crockett Health Care Associates, Inc.

• All providers in Crockett, TX
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.