1669569984 NPI number — IRVING-COPPELL SURGICAL HOSPITAL LLP

Table of content: (NPI 1669569984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669569984 NPI number — IRVING-COPPELL SURGICAL HOSPITAL LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRVING-COPPELL SURGICAL HOSPITAL LLP
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:
BAYLOR SCOTT & WHITE SURGICAL HOSPITAL - LAS COLINAS
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:
1669569984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 W LYNDON B JOHNSON FWY STE 101B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75063-3718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-868-4000
Provider Business Mailing Address Fax Number:
972-868-4009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 WEST I-635
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75063-3842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-868-4000
Provider Business Practice Location Address Fax Number:
972-868-4009
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLEMING
Authorized Official First Name:
DONITA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
202-815-3665

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  007995 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 163936101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163936102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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