Provider Demographics
NPI:1962434860
Name:NORTHWEST TEXAS HEALTHCARE SYSTEM, INC
Entity type:Organization
Organization Name:NORTHWEST TEXAS HEALTHCARE SYSTEM, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIRACLE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:806-468-4390
Mailing Address - Street 1:PO BOX 9633
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-9633
Mailing Address - Country:US
Mailing Address - Phone:806-354-1000
Mailing Address - Fax:
Practice Address - Street 1:814 MARTIN RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-6814
Practice Address - Country:US
Practice Address - Phone:806-468-4390
Practice Address - Fax:806-342-4789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137245005Medicaid
TX00U51QMedicare PIN