MEDICARE: WEST WHARTON COUNTY HOSPITAL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1265291447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST WHARTON COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	6649 N RIVERSIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6640
Country	:	US
Telephone Number	:	817-847-1860
Fax Number	:

Provider Business Practice Location Address
First Line	:	6649 N RIVERSIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6640
Country	:	US
Telephone Number	:	817-847-1860
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JOHNNY BOOTH THOMPSON
Credential	:
Telephone Number	:	361-576-9454

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	08/02/2024

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Directions to “WEST WHARTON COUNTY HOSPITAL DISTRICT ” Practice Location

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