Organization
GLEN ROSE MEDICAL FOUNDATION
Active
Other names
GLEN ROSE MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
HAL MAYO (CFO)
(254) 897-2215
Entity
Organization
Contact information
Practice address
1021 HOLDEN ST, GLEN ROSE, TX 76043-4937
(254) 897-2215
(254) 897-1446
Mailing address
PO BOX 2099, GLEN ROSE, TX 76043-2099
(254) 897-2215
(254) 897-1446
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
000059
TX
207P00000X
Emergency Medicine Physician
000059
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
000059
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0050KU
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/15/2006
Last updated
09/11/2025
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