Basic Information
| Provider Information | |||||||||
| NPI: | 1699726406 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLUMBIA MEDICAL CENTER OF PLANO SUBSIDIARY LP | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MEDICAL CITY PLANO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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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: | 05/15/2006 | ||||||||
| LastUpdateDate: | 06/02/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MCLEROY | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9725191520 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 010136334 | 05 | VA | MEDICAID | 11260B | 05 | SC | MEDICAID | 1700550 | 05 | LA | MEDICAID | 2374621 | 05 | OH | MEDICAID | 166012100 | 01 | DEPT OF LABOR | OTHER | 016152308 | 05 | MO | MEDICAID | 200027750A | 05 | OK | MEDICAID | 390562636A | 05 | GA | MEDICAID | 806728400 | 05 | ID | MEDICAID | HOS0651N | 05 | AL | MEDICAID | 60004851 | 05 | CO | MEDICAID | 100421280A | 05 | KS | MEDICAID | 119358900 | 05 | WY | MEDICAID | 20001779 | 05 | NH | MEDICAID | 200391040A | 05 | IN | MEDICAID | 4500651 | 05 | NC | MEDICAID | 823577 | 05 | AZ | MEDICAID | HH0715 | 01 | BLUE CROSS | OTHER | XHSP33441 | 05 | CA | MEDICAID | 911494700 | 05 | FL | MEDICAID | 031243600 | 05 | MN | MEDICAID | 304741986 | 05 | MI | MEDICAID | 9802091000 | 05 | WV | MEDICAID | 0220769 | 05 | MS | MEDICAID | 101144572 | 05 | PA | MEDICAID | 127311205 | 05 | TX | MEDICAID | 146007105 | 05 | AR | MEDICAID |