# SID PETERSON MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PETERSON REGIONAL MEDICAL CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790782704
- **Authorized official:** LISA MEDOVICH (CFO)
- **Authorized official phone:** (830) 258-7632

## Contact information

- **Practice address:** 551 HILL COUNTRY DR, KERRVILLE, TX 78028-6085
- **Practice address phone:** (830) 896-4200
- **Practice address fax:** (830) 258-7678
- **Mailing address:** 551 HILL COUNTRY DR, KERRVILLE, TX 78028-6085
- **Mailing address phone:** (830) 896-4200
- **Mailing address fax:** (830) 258-7678

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 282NR1301X | Rural Acute Care Hospital | 000406 | TX | Yes |

## Other

- **Enumeration date:** 07/05/2005
- **Last updated:** 07/27/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 127294003 | — | TX |
| 01 | — | HH0439 | BLUE CROSS BLUE SHIELD | TX |