NPIMap

Organization Active NPI

Scott & White Memorial Hospital

Doing business as Baylor Scott & White Dialysis Center - Killeen West

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Killeen, TX
National Provider Identifier
1508916826
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
SCOTT & WHITE MEMORIAL HOSPITAL
Doing business as
Baylor Scott & White Dialysis Center - Killeen West
Practice address
2201 S W S Young Dr Ste 101B
Killeen, TX 76543-5316
Phone
(254) 501-6467
NPI assigned
Jan 11, 2007
Last updated
Aug 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Authorized official

Name
Christopher L Olsen
Title
Cfo
Phone
(254) 724-4556

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

2201 S W S Young Dr Ste 101B
Killeen, TX 76543-5316

Mailing address

2201 S W S Young Dr Ste 101B
Killeen, TX 76543-5316
Phone (254) 550-6466

Other names 1

  • Baylor Scott & White Dialysis Center - Killeen West Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070201000281 TX Part A Provider - End-Stage Renal Disease Facility (ESRD) 8123076015 Practice locations: Killeen, TX

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1069583Baylor Scott & White Dialysis Center-Killeen2201 S W S Young Ste 101B, Killeen, TX 76543Certificate of waiverJun 7, 2027

National Provider Directory

National Provider Directory
Tax ID family
Scott White Memorial16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

2201 S W S Young Dr
Ste 101B
Killeen, TX 76543
Phone (254) 501-5837

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Baylor Scott & White Medical Center HillcrestWaco, TX, CCN 45T101 Hospital Operational/Managerial Control Jan 1, 2025
Adventhealth Central TexasKilleen, TX, CCN 450152 Hospital 5% Or Greater Direct Ownership Interest (32%) Jul 1, 2008
Adventhealth Rollins BrookLampasas, TX, CCN 451323 Hospital 5% Or Greater Direct Ownership Interest (32%) Jul 1, 2008
Adventhealth Rollins Brook Swing Bed Skilled Nursing FacilityLampasas, TX, CCN 45Z323 Hospital 5% Or Greater Direct Ownership Interest (32%) Jul 1, 2008
Adventhealth Family Medicine Clinic Copperas CoveCopperas Cove, TX, CCN 673920 Rural health clinic 5% Or Greater Direct Ownership Interest (32%) Jul 1, 2008
Adventhealth Family Medicine Clinic LampasasLampasas, TX, CCN 458905 Rural health clinic 5% Or Greater Direct Ownership Interest (32%) Jul 1, 2008

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722470400000",
    "number": "1508916826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 S W S YOUNG DR STE 101B",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765435316",
            "telephone_number": "254-550-6466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 S W S YOUNG DR STE 101B",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765435316",
            "telephone_number": "254-501-6467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT & WHITE MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "OLSEN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "254-724-4556"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baylor Scott & White Dialysis Center - Killeen West",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Killeen, TX

Sources for this page

Verify at the official NPI Registry.