Healthcare Provider Details

I. General information

NPI: 1740973023
Provider Name (Legal Business Name): WEST WHARTON COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/01/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 ENGLEWOOD LN
ODESSA TX
79762-7073
US

IV. Provider business mailing address

4150 INTERNATIONAL PLZ STE 600
FORT WORTH TX
76109-4831
US

V. Phone/Fax

Practice location:
  • Phone: 432-362-2583
  • Fax:
Mailing address:
  • Phone: 817-348-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID H MAK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 713-569-7370