Provider Demographics
NPI:1043681356
Name:TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH
Entity Type:Organization
Organization Name:TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:L
Authorized Official - Last Name:AMPARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-250-7771
Mailing Address - Street 1:PO BOX 916063
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76191-6063
Mailing Address - Country:US
Mailing Address - Phone:682-236-3576
Mailing Address - Fax:682-236-4608
Practice Address - Street 1:1301 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2122
Practice Address - Country:US
Practice Address - Phone:817-882-3770
Practice Address - Fax:817-882-3781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000235261QR0404X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TXPENDINGMedicare Oscar/Certification