NPIMap

Organization Active NPI

Coryell County Memorial Hospital Authority

  • Skilled Nursing Facility
  • Dallas, TX
National Provider Identifier
1962891523
Registry record updated Jan 20, 2015
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
3505 S Buckner Blvd BLDG 5
Dallas, TX 75227-5451
Phone
(214) 381-1815
Fax
(214) 275-7618
NPI assigned
Jan 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2015

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

Authorized official

Name
David K Byrom
Title
Ceo
Phone
(254) 248-6300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

3505 S Buckner Blvd BLDG 5
Dallas, TX 75227-5451

Mailing address

3505 S Buckner Blvd BLDG 5
Dallas, TX 75227-5451
Phone (214) 381-1815

Other identifiers 1

IdentifierTypeStateIssuer
104549MedicaidTX

Other names 1

  • BRENTWOOD PLACE IV Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Demetrios Katsaros39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421712000000",
    "number": "1962891523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 S BUCKNER BLVD BLDG 5",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752275451",
            "telephone_number": "214-381-1815",
            "fax_number": "214-275-7618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 S BUCKNER BLVD BLDG 5",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752275451",
            "telephone_number": "214-381-1815",
            "fax_number": "214-275-7618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORYELL COUNTY MEMORIAL HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-20",
        "last_updated": "2015-01-20",
        "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"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104549",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRENTWOOD PLACE IV",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; 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.