Healthcare Provider Details

I. General information

NPI: 1568656502
Provider Name (Legal Business Name): USMD HOSPITAL AT FORT WORTH, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 DIRKS RD
FORT WORTH TX
76132-5473
US

IV. Provider business mailing address

6333 N STATE HIGHWAY 161 SUITE 200
IRVING TX
75038-2215
US

V. Phone/Fax

Practice location:
  • Phone: 817-433-9100
  • Fax:
Mailing address:
  • Phone: 214-493-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. KAREN A FIDUCIA
Title or Position: CHAIRMAN OF THE BOARD OF DIRECTORS
Credential:
Phone: 214-493-4000