1730278417 NPI number — TEXAS HEALTH SPECIALTY HOSPITAL FORT WORTH

Table of content: (NPI 1730278417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730278417 NPI number — TEXAS HEALTH SPECIALTY HOSPITAL FORT WORTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS HEALTH SPECIALTY HOSPITAL FORT WORTH
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:
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 Information

NPI Number:
1730278417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 E BORDER ST # 124
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76010-7445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-890-6034
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 PENNSYLVANIA AVE
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:
76104-2122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-882-3770
Provider Business Practice Location Address Fax Number:
817-570-8199
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  000652 , 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: HH0915 . This is a "BLUE CROSS CONTINUED CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 232200200 . This is a "DEPT OF LABOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HOHH091501 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0942054-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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