Healthcare Provider Details

I. General information

NPI: 1417980202
Provider Name (Legal Business Name): TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 HARRIS PKWY
FORT WORTH TX
76132-4101
US

IV. Provider business mailing address

PO BOX 916047
FORT WORTH TX
76191-6047
US

V. Phone/Fax

Practice location:
  • Phone: 817-433-6565
  • Fax: 817-433-6574
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 Number000627
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number000627
License Number StateTX

VIII. Authorized Official

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