Provider Demographics
NPI:1073511762
Name:BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE
Entity type:Organization
Organization Name:BAYLOR REGIONAL MEDICAL CENTER AT GRAPEVINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-962-0487
Mailing Address - Street 1:PO BOX 847229
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7229
Mailing Address - Country:US
Mailing Address - Phone:214-820-3151
Mailing Address - Fax:214-818-5744
Practice Address - Street 1:1650 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3565
Practice Address - Country:US
Practice Address - Phone:817-481-1588
Practice Address - Fax:817-329-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000513282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127262703Medicaid
TX450563Medicare Oscar/Certification