NPIMap

Organization Active NPI

Coryell County Memorial Hospital Authority

  • Skilled Nursing Facility
  • Waco, TX
National Provider Identifier
1609201193
Registry record updated Sep 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY
Practice address
820 Jeffrey St
Waco, TX 76710-4745
Phone
(254) 772-9480
Fax
(254) 772-2885
NPI assigned
Sep 4, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2013

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

Authorized official

Name
David Byrom
Title
Ceo
Phone
(254) 248-6204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

820 Jeffrey St
Waco, TX 76710-4745

Mailing address

820 Jeffrey St
Waco, TX 76710-4745
Phone (254) 772-9480

Other identifiers 1

IdentifierTypeStateIssuer
004776MedicaidTX

Other names 1

  • Jeffrey Place Healthcare Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Coryell County Memorial Hospital Authority7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378252800000",
    "number": "1609201193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 JEFFREY ST",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767104745",
            "telephone_number": "254-772-9480",
            "fax_number": "254-772-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 JEFFREY ST",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767104745",
            "telephone_number": "254-772-9480",
            "fax_number": "254-772-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-04",
        "last_updated": "2013-09-04",
        "status": "A",
        "authorized_official_last_name": "BYROM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "254-248-6204"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004776",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jeffrey Place Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2013; 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.