1104845015 NPI number — TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104845015 NPI number — TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD

Employer Identification Number (EIN):

Provider Organization Name:

TEXAS HEALTH HARRIS METHODIST HOSPITAL HURST-EULESS-BEDFORD

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

Provider Other Organization Name Type Code:

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:

1104845015

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

04/22/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 731467

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DALLAS

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

75373-1467

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

800-890-6034

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1600 HOSPITAL PKWY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BEDFORD

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

76022-6913

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

817-685-4011

Provider Business Practice Location Address Fax Number:

817-685-4469

Provider Enumeration Date:

07/19/2006

Authorized Official Last Name:

MINCHER

Authorized Official First Name:

JEFF

Authorized Official Middle Name:

Authorized Official Title or Position:

SENIOR VP REVENUE CYCLE

Authorized Official Telephone Number:

682-236-3013

• Taxonomy code: 261QA1903X , with the licence number:  000182 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 282N00000X , with the licence number: 000182 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 014610 . This is a "KIDNEY HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: HH0678 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: HOHH067801 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 324996800 . This is a "DEPT OF LABOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 450639B000000 . This is a "SECTION 1011" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 136326904 . This is a "MEDICAID HASCO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 103869100 . This is a "FIRSTCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 136326908 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".