Healthcare Provider Details

I. General information

NPI: 1326363599
Provider Name (Legal Business Name): JPS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST JPS HOSPITAL - DEPT OB/GYN
FORT WORTH TX
76104-4917
US

IV. Provider business mailing address

1500 S MAIN ST JPS HOSPITAL - DEPT OB/GYN
FORT WORTH TX
76104-4917
US

V. Phone/Fax

Practice location:
  • Phone: 817-927-1065
  • Fax: 817-927-1162
Mailing address:
  • Phone: 817-927-1065
  • Fax: 817-927-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberN0726
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberN0726
License Number StateTX

VIII. Authorized Official

Name: DR. JACKQUELIN DELGADO
Title or Position: OB/GYN RESIDENT PHYSICIAN
Credential: M.D.
Phone: 817-927-1065