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	:	1558966317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST WHARTON COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	4150 INTERNATIONAL PLAZA
Second Line	:	SUITE 600
City	:	FORTH WORTH
State	:	TX
Zip	:	76109-4831
Country	:	US
Telephone Number	:	817-348-8959
Fax Number	:	817-348-0466

Provider Business Practice Location Address
First Line	:	3600 ANGLE AVENUE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76106-3559
Country	:	US
Telephone Number	:	817-624-6164
Fax Number	:	817-624-7523

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. DAVID MAK
Credential	:
Telephone Number	:	979-578-5250

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	02/25/2022

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Directions to “WEST WHARTON COUNTY HOSPITAL DISTRICT ” Practice Location

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