Basic Information
| Provider Information | |||||||||
| NPI: | 1336172105 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 916063 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761916063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008906034 | ||||||||
| FaxNumber: | 6822360103 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178823770 | ||||||||
| FaxNumber: | 8178823781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 04/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | MINCHER | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VP REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 6822363013 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 000235 | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 282N00000X | 000235 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 112677302 | 05 | TX | MEDICAID | 181895800 | 01 | TX | DEPT OF LABOR | OTHER | HOHH004901 | 01 | TX | BCBS | OTHER | HH0049 | 01 | TX | BLUE CROSS ACUTE | OTHER | 103874100 | 01 | TX | FIRSTCARE | OTHER | 003114 | 01 | TX | KIDNEY HEALTH | OTHER | 112677301 | 01 | TX | MEDICAID HASCO | OTHER | 450135B000000 | 01 | TX | SECTION 1011 | OTHER |