Basic Information
| Provider Information | |||||||||
| NPI: | 1154056158 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST WHARTON COUNTY HOSPITAL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4150 INTERNATIONAL PLZ STE 600 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761094831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173488959 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 N BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | BALLINGER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 768212418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3253652538 | ||||||||
| FaxNumber: | 6822578671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2022 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | MAK | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7135697370 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.