1023069739 NPI number — COLUMBIA MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP

Table of content: (NPI 1023069739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023069739 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:
1023069739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PARK PLZ
Provider Second Line Business Mailing Address:
REGULATORY COMPLIANCE SUPPORT, BLDG. 2-3 W
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-6527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-420-7602
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:
75057-3641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-420-7602
Provider Business Practice Location Address Fax Number:
972-420-1073
Provider Enumeration Date:
05/15/2006

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: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 094192401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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