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	:	1366177305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST WHARTON COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	4150 INTERNATIONAL PLZ STE 600
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4831
Country	:	US
Telephone Number	:	817-348-8959
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 ENTERPRISE AVE
Second Line	:
City	:	DEVINE
State	:	TX
Zip	:	78016-1807
Country	:	US
Telephone Number	:	830-663-4451
Fax Number	:	682-257-8730

Authorized Official
Title or Position	:	CFO
Name	:	DAVID H MAK
Credential	:
Telephone Number	:	713-569-7370

Provider Enumeration Date	:	07/22/2022
Last Update Date	:	07/22/2022

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Directions to “WEST WHARTON COUNTY HOSPITAL DISTRICT ” Practice Location

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