Basic Information
| Provider Information | |||||||||
| NPI: | 1740305119 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 E BORDER ST | ||||||||
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| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760107445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175708500 | ||||||||
| FaxNumber: | 6822364620 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 DENVER TRL | ||||||||
| Address2: | |||||||||
| City: | AZLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760203614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172502565 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 11/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | ELLZEY | ||||||||
| AuthorizedOfficialFirstName: | BOB | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8174448780 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 11/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 000469 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 010151 | 05 | TX | MEDICAID |