Provider Demographics
NPI:1598164881
Name:PALO PINTO COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PALO PINTO COUNTY HOSPITAL DISTRICT
Other - Org Name:WEDGEWOOD NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WHIDDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-328-6401
Mailing Address - Street 1:6621 DAN DANCIGER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-4905
Mailing Address - Country:US
Mailing Address - Phone:817-292-6330
Mailing Address - Fax:817-346-7980
Practice Address - Street 1:6621 DAN DANCIGER RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-4905
Practice Address - Country:US
Practice Address - Phone:817-292-6330
Practice Address - Fax:817-346-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004960Medicaid
TX455572Medicare Oscar/Certification