1730238791 NPI number — HARRIS METHODIST SPRINGWOOD

Table of content: (NPI 1730238791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730238791 NPI number — HARRIS METHODIST SPRINGWOOD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRIS METHODIST SPRINGWOOD
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:
6
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:
1730238791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 916060
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:
76191-6060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-890-6034
Provider Business Mailing Address Fax Number:
682-236-0103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2717 TIBBETS DRIVE
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:
01/09/2007

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: 273R00000X , with the licence number:  000778 , 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: HH1036 . This is a "PSY INPATIENT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HOHH359901 . This is a "SUBSTANCE ABUSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HOHH103601 . This is a "BCBS PSY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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