Provider Demographics
NPI:1144333691
Name:FORT WORTH OSTEOPATHC HOSPITAL, INC.
Entity type:Organization
Organization Name:FORT WORTH OSTEOPATHC HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-651-6508
Mailing Address - Street 1:1401 ELM ST STE 4750
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-2992
Mailing Address - Country:US
Mailing Address - Phone:214-651-6508
Mailing Address - Fax:214-744-2615
Practice Address - Street 1:1000 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2625
Practice Address - Country:US
Practice Address - Phone:214-651-6508
Practice Address - Fax:214-744-2615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX450121Medicare ID - Type Unspecified