Provider Demographics
NPI:1912130774
Name:TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH
Entity Type:Organization
Organization Name:TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH
Other - Org Name:TEXAS HEALTH MEDICAL LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP 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 1:1401 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2113
Mailing Address - Country:US
Mailing Address - Phone:817-250-5672
Mailing Address - Fax:817-250-5579
Practice Address - Street 1:1401 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2113
Practice Address - Country:US
Practice Address - Phone:817-250-5672
Practice Address - Fax:817-250-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087501OtherCOLLEGE OF AMERICAN PATHOLOGIST
45D0701182OtherCLIA