Provider Demographics
NPI:1336172105
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:SENIOR VP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MINCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-236-3013
Mailing Address - Street 1:PO BOX 916063
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76191-6063
Mailing Address - Country:US
Mailing Address - Phone:800-890-6034
Mailing Address - Fax:682-236-0103
Practice Address - Street 1:1301 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT 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:2006-07-07
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000235261QA1903X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112677302Medicaid
TX181895800OtherDEPT OF LABOR
TXHOHH004901OtherBCBS
TXHH0049OtherBLUE CROSS ACUTE
TX103874100OtherFIRSTCARE
TX003114OtherKIDNEY HEALTH
TX112677301OtherMEDICAID HASCO
TX450135B000000OtherSECTION 1011