Provider Demographics
NPI:1275690216
Name:DECATUR HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:DECATUR HOSPITAL AUTHORITY
Other - Org Name:WISE REGIONAL HEALTH SYSTEM - PSYCH UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-626-8671
Mailing Address - Street 1:2000 S FM 51
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3702
Mailing Address - Country:US
Mailing Address - Phone:940-627-5921
Mailing Address - Fax:940-393-0561
Practice Address - Street 1:2000 SOUTH FM 51
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234
Practice Address - Country:US
Practice Address - Phone:940-627-5921
Practice Address - Fax:940-393-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130606008Medicaid