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DSH450054CZ SCOTT AND WHITE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
Scott and White Killeen Dermatology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450054CZ
Medicare Provider Number
450054
Outpatient Facility Provider Number
450054
Additional Details
Current Program Status
Terminated
Registration Date
7/7/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/4/2014
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
3801 Scott and White Drive
Killeen, TX 76543
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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