Basic Information
| Provider Information | |||||||||
| NPI: | 1033120423 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS HEALTH HUGULEY, INC. | ||||||||
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| OtherOrganizationName: | TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6337 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761150337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175512740 | ||||||||
| FaxNumber: | 8175681296 | ||||||||
| Practice Location | |||||||||
| Address1: | 11801 SOUTH FWY | ||||||||
| Address2: | |||||||||
| City: | BURLESON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760287021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175512740 | ||||||||
| FaxNumber: | 8175681296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 01/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | PENNY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8175512704 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 100157 | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 282N00000X | 100157 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | HH3237 | 01 | TX | BCBS CD | OTHER | 104123100 | 01 | TX | FIRST HEALTH | OTHER | 131205 | 01 | TX | VALUE BEHAVIORAL HEALTH | OTHER | 314080801 | 05 | TX | MEDICAID | 314080802 | 05 | TX | MEDICAID | 58290 | 01 | TX | AETNA | OTHER | HH6510 | 01 | TX | BCBS PHP | OTHER | 18147 | 01 | TX | SCOTT & WHITE HEALTH | OTHER | HH0732 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 450677 | 01 | TX | UNICARE PPO | OTHER | 6541690 | 01 | TX | AETNA | OTHER | 15515001 | 01 | TX | PACIFICARE | OTHER | 237219332 | 01 | TX | CHAMPUS/VA/TRICARE | OTHER | 450677 | 01 | TX | STERLING | OTHER |