1720354590 NPI number — NORTHWEST TEXAS HEALTHCARE SYSTEM INC

Table of content: (NPI 1720354590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720354590 NPI number — NORTHWEST TEXAS HEALTHCARE SYSTEM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST TEXAS HEALTHCARE SYSTEM 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:
NORTHWEST TEXAS HEALTHCARE SYSTEM ANESTHESIA
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:
1720354590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4100 INTERNATIONAL PLZ STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76109-4823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-529-2650
Provider Business Mailing Address Fax Number:
817-529-3088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 S COULTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-1770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-354-1000
Provider Business Practice Location Address Fax Number:
806-354-1122
Provider Enumeration Date:
03/27/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STRAIT
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-204-6747

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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