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DSH450054CH SCOTT AND WHITE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SCOTT AND WHITE MEMORIAL HOSPITAL
Subdivision Name
Scott and White Gatesville Anti-Coagulation Service
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450054CH
Medicare Provider Number
450054
Outpatient Facility Provider Number
450054
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2014
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
227 Memorial Drive
Gatesville, TX 76528
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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