Provider Demographics
NPI:1730278417
Name:TEXAS HEALTH SPECIALTY HOSPITAL FORT WORTH
Entity type:Organization
Organization Name:TEXAS HEALTH SPECIALTY 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 1:500 E BORDER ST # 124
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-7445
Mailing Address - Country:US
Mailing Address - Phone:800-890-6034
Mailing Address - Fax:
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:817-570-8199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRIS METHODIST FORT WORTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-12
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000652282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH0915OtherBLUE CROSS CONTINUED CARE
TX232200200OtherDEPT OF LABOR
TXHOHH091501OtherBCBS
TX0942054-01Medicaid