Basic Information
| Provider Information | |||||||||
| NPI: | 1043328222 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METHODIST HOSPITAL LEVELLAND | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COVENANT HOSPITAL LEVELLAND | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | LEVELLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793366508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068944963 | ||||||||
| FaxNumber: | 8068946461 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | LEVELLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068944963 | ||||||||
| FaxNumber: | 8068946461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 06/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | WHITE | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
| AuthorizedOfficialMiddleName: | BRUCE | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8068944963 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | METHODIST HOSPITAL LEVELLAND | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 000307 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 103182100 | 01 | TX | FIRSTCARE/SWL&H/CHIPS | OTHER | 13325870502 | 05 | TX | MEDICAID |