1669569984 NPI number — IRVING-COPPELL SURGICAL HOSPITAL LLP

Table of Contents

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:
Provider Other Organization Name Type Code:
6
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:
10/09/2024
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: 163936102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163936101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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