Basic Information
| Provider Information | |||||||||
| NPI: | 1538177589 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 E BORDER ST | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760107445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175708500 | ||||||||
| FaxNumber: | 6822364620 | ||||||||
| Practice Location | |||||||||
| Address1: | 6100 HARRIS PKWY | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761324101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174336565 | ||||||||
| FaxNumber: | 8174336574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 11/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | CHARLOTTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP, FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 8174336565 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 11/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 000627 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 282N00000X | 000627 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | CG5308 | 01 | TX | MEDICARE RAILROAD | OTHER |