Basic Information
| Provider Information | |||||||||
| NPI: | 1669566584 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SCOTT & WHITE MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BAYLOR SCOTT & WHITE HOSPICE - WACO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 847788 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752847788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547242111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2911 HERRING AVE | ||||||||
| Address2: | STE 310 | ||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542025150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 08/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | CANTU | ||||||||
| AuthorizedOfficialFirstName: | ALICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SYSTEM DIRECTOR, CBS | ||||||||
| AuthorizedOfficialTelephone: | 2542159719 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 013728 | TX | Y | Agencies | Hospice Care, Community Based |
No ID Information.