1902047376 NPI number — FLOWER MOUND HOSPITAL PARTNERS, LLC

Table of content: (NPI 1902047376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902047376 NPI number — FLOWER MOUND HOSPITAL PARTNERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLOWER MOUND HOSPITAL PARTNERS, LLC
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:
TEXAS HEALTH PRESBYTERIAN HOSPITAL FLOWER MOUND
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:
1902047376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4400 LONG PRAIRIE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75028-1892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-322-7089
Provider Business Mailing Address Fax Number:
469-464-3771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 LONG PRAIRIE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLOWER MOUND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75028-1752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-419-6704
Provider Business Practice Location Address Fax Number:
972-419-8118
Provider Enumeration Date:
03/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CRAFT
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM PRESIDENT
Authorized Official Telephone Number:
682-236-2005

Provider Taxonomy Codes

  • Taxonomy code: 261QC0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 217744601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 217744602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100056 . This is a "DSHS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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