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DSH450054I SCOTT AND WHITE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
SCOTT AND WHITE CENTER FOR DIAGNOSTIC MEDICINE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450054I
Medicare Provider Number
450054
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/28/2007
Participating Start Date
1/1/2008
Participating Approval Date
11/28/2007
Last Recertification Date
8/29/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Baylor Scott & White Medical Center - Temple
Shahin Motakef, CEO
(254) 724-6583
Primary Contact
Shahin Motakef, CEO
(254) 724-6583
Addresses
Street Address
1605 S. 31ST ST.
TEMPLE, TX 76508
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/26/08-DOC RECD TO CONFIRM ELIG DSH ADJ %
11/28/2007
April 2025
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