Basic Information
| Provider Information | |||||||||
| NPI: | 1326363599 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JPS HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 S MAIN ST | ||||||||
| Address2: | JPS HOSPITAL - DEPT OB/GYN | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761044917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179271065 | ||||||||
| FaxNumber: | 8179271162 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 S MAIN ST | ||||||||
| Address2: | JPS HOSPITAL - DEPT OB/GYN | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761044917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179271065 | ||||||||
| FaxNumber: | 8179271162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2010 | ||||||||
| LastUpdateDate: | 03/31/2010 | ||||||||
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| AuthorizedOfficialLastName: | DELGADO | ||||||||
| AuthorizedOfficialFirstName: | JACKQUELIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OB/GYN RESIDENT PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8179271065 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | N0726 | TX | N | Hospitals | General Acute Care Hospital | 207V00000X | N0726 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.