Healthcare Provider Details

I. General information

NPI: 1336172105
Provider Name (Legal Business Name): TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PENNSYLVANIA AVE
FORT WORTH TX
76104-2122
US

IV. Provider business mailing address

PO BOX 916063
FORT WORTH TX
76191-6063
US

V. Phone/Fax

Practice location:
  • Phone: 817-882-3770
  • Fax: 817-882-3781
Mailing address:
  • Phone: 800-890-6034
  • Fax: 682-236-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number000235
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number000235
License Number StateTX

VIII. Authorized Official

Name: JEFF MINCHER
Title or Position: SENIOR VP REVENUE CYCLE
Credential:
Phone: 682-236-3013