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Organization
SID PETERSON MEMORIAL HOSPITAL
Active
Organization
SID PETERSON MEMORIAL HOSPITAL
Active
Other names
Peterson Home Care
Organization subpart
No
Provider details
NPI number
Authorized official
LISA MEDOVICH (CHIEF FINANCIAL OFFICER)
(830) 258-7632
Entity
Organization
Contact information
Practice address
250 CULLY DR, KERRVILLE, TX 78028-5950
(830) 258-7400
(830) 896-5859
Mailing address
551 HILL COUNTRY DR, KERRVILLE, TX 78028-6085
(830) 257-3111
(830) 896-5859
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
002114
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002114
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
TX
05
—
091526602
—
TX
Enumeration date
03/16/2006
Last updated
07/27/2022
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