Organization
MEMORIAL HOSPITAL POLK COUNTY
Active
Other names
EKG Group
Organization subpart
No
Provider details
NPI number
Authorized official
FONDA R SULLIVAN (INSURANCE SUPERVISOR)
(936) 631-3474
Entity
Organization
Contact information
Practice address
1717 HIGHWAY 59 LOOP N, LIVINGSTON, TX 77351-5703
(936) 631-3474
(936) 631-3475
Mailing address
1717 HIGHWAY 59 LOOP N, LIVINGSTON, TX 77351-5703
(936) 631-3474
(936) 631-3475
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
H9325
TX
174400000X
Specialist
K2507
TX
174400000X
Specialist
K3772
TX
174400000X
Specialist
Primary
L0081
TX
174400000X
Specialist
L9581
TX
Other
Enumeration date
05/30/2006
Last updated
08/22/2020
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