Healthcare Provider Details

I. General information

NPI: 1750509998
Provider Name (Legal Business Name): HARRIS METHODIST HOSPITAL HEB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HOSPITAL PKWY
BEDFORD TX
76022-6913
US

IV. Provider business mailing address

6000 STERLING DR
COLLEYVILLE TX
76034-7632
US

V. Phone/Fax

Practice location:
  • Phone: 817-685-4000
  • Fax:
Mailing address:
  • Phone: 817-581-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberDT05147
License Number StateTX

VIII. Authorized Official

Name: MRS. VICKI LEE KUSSMAUL
Title or Position: CLINICAL DIETITIAN
Credential: R.D.
Phone: 817-685-4823