1255384533 NPI number — COLUMBIA MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP

Table of content: (NPI 1255384533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255384533 NPI number — COLUMBIA MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDICAL CITY LEWISVILLE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255384533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75057-3629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-420-1000
Provider Business Mailing Address Fax Number:
972-420-1073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75057-3629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-420-1000
Provider Business Practice Location Address Fax Number:
972-420-1073
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STUTTS
Authorized Official First Name:
MIAH
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
972-420-1556

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11117A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146098105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166018400 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100689660A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200390940A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 910927700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000593975X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015783905 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 351303300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806722000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0548578 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07051779 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1764663 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP30118 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4500669 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82274500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: A7174 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010136423 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200002000A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3024924 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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