Basic Information
| Provider Information | |||||||||
| NPI: | 1588618557 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLUMBIA MEDICAL CENTER OF PLANO SUBSIDIARY LP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEDICAL CITY PLANO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3901 W 15TH ST | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750757738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725966800 | ||||||||
| FaxNumber: | 9725191295 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 W 15TH ST | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750757738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725966800 | ||||||||
| FaxNumber: | 9725191295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 11/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | MCLEROY | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9725191520 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 127311202 | 05 | TX | MEDICAID |