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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1755	OTHER	TX	4 DIGIT ZIP CODE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700228632
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	:	FORT 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	:	6641 WEST AMARILLO BOULEVARD
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-1755
Country	:	US
Telephone Number	:	806-352-8800
Fax Number	:	806-352-8812

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

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	07/01/2022

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Directions to “WEST WHARTON COUNTY HOSPITAL DISTRICT ” Practice Location

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