MEDICARE: PALO PINTO 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598164881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALO PINTO COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	6621 DAN DANCIGER RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4905
Country	:	US
Telephone Number	:	817-292-6330
Fax Number	:	817-346-7980

Provider Business Practice Location Address
First Line	:	6621 DAN DANCIGER RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4905
Country	:	US
Telephone Number	:	817-292-6330
Fax Number	:	817-346-7980

Authorized Official
Title or Position	:	CFO
Name	:	DOUGLAS P SELSOR
Credential	:
Telephone Number	:	940-328-6401

Provider Enumeration Date	:	08/22/2014
Last Update Date	:	08/08/2025

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