Provider Demographics
NPI:1609053974
Name:WEST 380 FAMILY CARE FACILITY
Entity Type:Organization
Organization Name:WEST 380 FAMILY CARE FACILITY
Other - Org Name:DOCTORS' HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:IBARRA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:940-683-0300
Mailing Address - Street 1:1905 DOCTORS HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-2260
Mailing Address - Country:US
Mailing Address - Phone:940-683-5425
Mailing Address - Fax:940-683-4327
Practice Address - Street 1:1905 DOCTORS HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2260
Practice Address - Country:US
Practice Address - Phone:940-683-5425
Practice Address - Fax:940-683-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X, 282N00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197807401Medicaid
TX197807401Medicaid