1144333691 NPI number — FORT WORTH OSTEOPATHC HOSPITAL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144333691 NPI number — FORT WORTH OSTEOPATHC HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORT WORTH OSTEOPATHC HOSPITAL, INC.
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:
OSTEOPATHIC MEDICAL CENTER OF TEXAS
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:
1144333691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 ELM ST STE 4750
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:
75202-2992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-651-6508
Provider Business Mailing Address Fax Number:
214-744-2615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 MONTGOMERY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76107-2625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-651-6508
Provider Business Practice Location Address Fax Number:
214-744-2615
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
TRUSTEE
Authorized Official Telephone Number:
214-651-6508

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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