Provider Demographics
NPI:1871704155
Name:SWISHER MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:SWISHER MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-995-8268
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:TULIA
Mailing Address - State:TX
Mailing Address - Zip Code:79088-0808
Mailing Address - Country:US
Mailing Address - Phone:806-995-3581
Mailing Address - Fax:806-995-8283
Practice Address - Street 1:539 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:TULIA
Practice Address - State:TX
Practice Address - Zip Code:79088-2400
Practice Address - Country:US
Practice Address - Phone:806-995-2235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWISHER MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-25
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130721704Medicaid
TX106385100OtherFIRSTCARE
TXHH0321OtherBCBS
TX0882599-01Medicaid
TX130721704Medicaid