Provider Demographics
NPI:1063436525
Name:TERRY MEMORIAL HOSPITAL DISTRICT
Entity type:Organization
Organization Name:TERRY MEMORIAL HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-637-3551
Mailing Address - Street 1:705 E FELT ST
Mailing Address - Street 2:
Mailing Address - City:BROWNFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79316-3439
Mailing Address - Country:US
Mailing Address - Phone:806-637-3551
Mailing Address - Fax:806-637-8102
Practice Address - Street 1:705 E FELT ST
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:TX
Practice Address - Zip Code:79316-3439
Practice Address - Country:US
Practice Address - Phone:806-637-3551
Practice Address - Fax:806-637-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
TX000078261QF0050X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130618507Medicaid
TX0062DEOtherBCBS CLINIC
TX130618506Medicaid
NMP6318Medicaid
TX131765100OtherFIRSTCARE CLINIC
TXHH0016OtherBLUE CROSS CROSSOVER
TX130618506Medicaid
TX130618506Medicaid