Healthcare Provider Details

I. General information

NPI: 1215296884
Provider Name (Legal Business Name): TEXAS HEALTH HARRIS METHODIST HOSPITAL ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10864 TEXAS HEALTH TRL
FORT WORTH TX
76244-4897
US

IV. Provider business mailing address

PO BOX 731778
DALLAS TX
75373-1778
US

V. Phone/Fax

Practice location:
  • Phone: 682-212-2000
  • Fax: 817-693-2510
Mailing address:
  • Phone: 800-890-6034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number100162
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number100162
License Number StateTX

VIII. Authorized Official

Name: MR. JEFF MINCHER
Title or Position: SENIOR VP REVENUE CYCLE
Credential:
Phone: 682-236-0103