Provider Demographics
NPI:1033120423
Name:TEXAS HEALTH HUGULEY, INC.
Entity Type:Organization
Organization Name:TEXAS HEALTH HUGULEY, INC.
Other - Org Name:TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-551-2704
Mailing Address - Street 1:PO BOX 6337
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-0337
Mailing Address - Country:US
Mailing Address - Phone:817-551-2740
Mailing Address - Fax:817-568-1296
Practice Address - Street 1:11801 SOUTH FWY
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7021
Practice Address - Country:US
Practice Address - Phone:817-551-2740
Practice Address - Fax:817-568-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100157261QA1903X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX237219332OtherCHAMPUS/VA/TRICARE
TX314080802Medicaid
TX18147OtherSCOTT & WHITE HEALTH
TX450677OtherUNICARE PPO
TX58290OtherAETNA
TX104123100OtherFIRST HEALTH
TX15515001OtherPACIFICARE
TX450677OtherSTERLING
TXHH6510OtherBCBS PHP
TX131205OtherVALUE BEHAVIORAL HEALTH
TXHH3237OtherBCBS CD
TX314080801Medicaid
TXHH0732OtherBLUE CROSS BLUE SHIELD
TX6541690OtherAETNA
TX450677Medicare Oscar/Certification
TX58290OtherAETNA