Healthcare Provider Details

I. General information

NPI: 1083602940
Provider Name (Legal Business Name): METHODIST HOSPITAL LEVELLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 JOHN DUPREE DR
LEVELLAND TX
79336-6326
US

IV. Provider business mailing address

PO BOX 677044
DALLAS TX
75267-7044
US

V. Phone/Fax

Practice location:
  • Phone: 806-894-2465
  • Fax: 806-894-8897
Mailing address:
  • Phone: 806-894-2465
  • Fax: 806-894-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number000307
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number000307
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number000307
License Number StateTX

VIII. Authorized Official

Name: DONALD W ANDERSON JR.
Title or Position: ASSISTANT SECRETARY OF ENROLLMENTS
Credential:
Phone: 425-358-9786