Provider Demographics
NPI:1831893296
Name:CHOT HEALTHCARE PROVIDERS
Entity type:Organization
Organization Name:CHOT HEALTHCARE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-870-2795
Mailing Address - Street 1:6100 WESTERN PL STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4662
Mailing Address - Country:US
Mailing Address - Phone:817-870-2795
Mailing Address - Fax:817-546-2173
Practice Address - Street 1:6100 WESTERN PL STE 105
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4662
Practice Address - Country:US
Practice Address - Phone:817-870-2795
Practice Address - Fax:817-546-2173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty