1033120423 NPI number — TEXAS HEALTH HUGULEY, INC.

Table of content: (NPI 1033120423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033120423 NPI number — TEXAS HEALTH HUGULEY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS HEALTH HUGULEY, 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:
TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH
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:
1033120423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6337
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:
76115-0337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-551-2740
Provider Business Mailing Address Fax Number:
817-568-1296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11801 SOUTH FWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLESON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76028-7021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-551-2740
Provider Business Practice Location Address Fax Number:
817-568-1296
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
PENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
817-551-2704

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  100157 , 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: 100157 , 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: 237219332 . This is a "CHAMPUS/VA/TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 314080802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18147 . This is a "SCOTT & WHITE HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 450677 . This is a "UNICARE PPO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 58290 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 104123100 . This is a "FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 15515001 . This is a "PACIFICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 450677 . This is a "STERLING" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH6510 . This is a "BCBS PHP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 131205 . This is a "VALUE BEHAVIORAL HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH3237 . This is a "BCBS CD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 314080801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0732 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 6541690 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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