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CAH451358-00 MEMORIAL HOSPITAL-SEMINOLE (Active)
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Main Details
Name
MEMORIAL HOSPITAL-SEMINOLE
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH451358-00
Medicare Provider Number
451358
Additional Details
Current Program Status
Active
Registration Date
1/10/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/28/2019
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Seminole Memorial Hospital
Maegen Garner, Interim CEO
(432) 758-4814
Primary Contact
Seminole Memorial Hospital
Deborah Anne Dabbs, Compliance Officer
(432) 758-4868
Addresses
Street Address
209 NORTHWEST 8TH STREET
SEMINOLE, TX 79360-3499
Billing Address
CAH PHCY SRVCS DIV 16
13651 Dublin Court
Stafford, TX 77477
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date (4/1/2012) until terminated effective date (10/1/2018), reinstatement effective date (04/01/2019)
01/16/2019
May 2025
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