| Organization Name: | GLEN ROSE MEDICAL FOUNDATION |
| NPI Number: | 1821032780 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HAL MAYO (CFO) |
| Mailing Address: | 1021 Holden St Glen Rose |
| State: | TX US |
| Postal Code: | 760434937 |
| Phone Number: | 2548972215 |
| Fax Number: | 2548971446 |
| NPI Enumeration Date: | 06/15/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 000059 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |