Provider Demographics
NPI:1487092755
Name:SCOTT AND WHITE HEALTHCARE
Entity type:Organization
Organization Name:SCOTT AND WHITE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIALYSIS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CDN
Authorized Official - Phone:254-724-6005
Mailing Address - Street 1:2201 S W S YOUNG DR STE 101B
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-5316
Mailing Address - Country:US
Mailing Address - Phone:254-501-6471
Mailing Address - Fax:254-501-6480
Practice Address - Street 1:2201 S W S YOUNG DR STE 101B
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5316
Practice Address - Country:US
Practice Address - Phone:254-501-6471
Practice Address - Fax:254-501-6480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT 80613261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT80613OtherTEXAS BOARD OF EXAMINERS