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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	004235	OTHER	TX	FACILITY ID

General Provider Information

NPI Number	:	1841563038
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	:	4320 WEST 19TH STREET
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79407-2407
Country	:	US
Telephone Number	:	806-795-1774
Fax Number	:	806-771-3868

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

Provider Enumeration Date	:	02/17/2012
Last Update Date	:	02/25/2022

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