Basic Information
| Provider Information | |||||||||
| NPI: | 1730238791 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARRIS METHODIST SPRINGWOOD | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | TEXAS HEALTH SPRINGWOOD HOSPITAL HURST-EULESS-BEDFORD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 916060 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761916060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008906034 | ||||||||
| FaxNumber: | 6822360103 | ||||||||
| Practice Location | |||||||||
| Address1: | 2717 TIBBETS DRIVE | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760226913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8176854011 | ||||||||
| FaxNumber: | 8176854469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MINCHER | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VP REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 6822363013 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 000778 | TX | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | HH1036 | 01 | TX | PSY INPATIENT | OTHER | HOHH359901 | 01 | TX | SUBSTANCE ABUSE | OTHER | HOHH103601 | 01 | TX | BCBS PSY | OTHER |