Provider Demographics
NPI:1598726358
Name:DECATUR HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:DECATUR HOSPITAL AUTHORITY
Other - Org Name:MIDWESTERN HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-626-1287
Mailing Address - Street 1:601 MIDWESTERN PKWY E
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2401
Mailing Address - Country:US
Mailing Address - Phone:940-723-0885
Mailing Address - Fax:940-763-8142
Practice Address - Street 1:601 MIDWESTERN PKWY E
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2401
Practice Address - Country:US
Practice Address - Phone:940-723-0885
Practice Address - Fax:940-763-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115948314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX005155OtherSTATE VENDOR NUMBER
TXHH345SOtherBCBS
TX001004347Medicaid
675128Medicare Oscar/Certification