MEDICARE: DECATUR HOSPITAL AUTHORITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	HH190D	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407229529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DECATUR HOSPITAL AUTHORITY

Provider Business Mailing Address
First Line	:	2000 S FM 51
Second Line	:
City	:	DECATUR
State	:	TX
Zip	:	76234-3702
Country	:	US
Telephone Number	:	940-627-5921
Fax Number	:	940-393-0561

Provider Business Practice Location Address
First Line	:	3200 N TARRANT PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8611
Country	:	US
Telephone Number	:	817-502-7300
Fax Number	:	817-502-7401

Authorized Official
Title or Position	:	CEO
Name	:	MR. JASON WREN
Credential	:
Telephone Number	:	940-626-8671

Provider Enumeration Date	:	11/11/2015
Last Update Date	:	02/09/2023

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Directions to “DECATUR HOSPITAL AUTHORITY ” Practice Location

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