1063678324 NPI number — TARRANT COUNTY HOSPITAL DISTRICT

Table of content: (NPI 1063678324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063678324 NPI number — TARRANT COUNTY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TARRANT COUNTY HOSPITAL DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TCHD GERTRUDE TARPLEY COMM CLINIC PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063678324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4701 BRYANT IRVIN RD N
Provider Second Line Business Mailing Address:
STE LL215
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76107-7627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-702-6640
Provider Business Mailing Address Fax Number:
817-533-7435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6601 WATAUGA RD
Provider Second Line Business Practice Location Address:
STE 126
Provider Business Practice Location Address City Name:
WATAUGA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76148-3331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-702-6640
Provider Business Practice Location Address Fax Number:
817-533-7435
Provider Enumeration Date:
08/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT PHARMACY SERVICES
Authorized Official Telephone Number:
806-242-7782

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 26130 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2116697 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 251022 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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