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SCH450587-03 Hendrick Medical Center Brownwood (Terminated)
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Main Details
Name
Hendrick Medical Center Brownwood
Subdivision Name
Hendrick Outpatient Rehabilitation Brownwood - PHYSICAL THERAPY - REMOTE 1
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH450587-03
Medicare Provider Number
450587
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/16/2021
Participating Start Date
3/22/2021
Participating Approval Date
3/22/2021
Last Recertification Date
8/25/2021
Termination Date
Termination Reason
10/1/2022
Change of covered entity type
Contacts
Authorizing Official
Hendrick Medical Center Brownood
Erich Wallschlaeger, Chief Financial Officer
(325) 649-3305
Primary Contact
Hendrick Medical Center
Robert Joseph Wray, pharmacist
(325) 670-6405
Addresses
Street Address
101 Streckert Dr.
Brownwood, TX 76801
Billing Address
Hendrick Medical Center Brownwood
1501 Burnett Rd.
Brownwood, TX 76801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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