Provider Demographics
NPI:1104405844
Name:PLATINUM MEDICAL CENTER PRINCETON
Entity type:Organization
Organization Name:PLATINUM MEDICAL CENTER PRINCETON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-422-1047
Mailing Address - Street 1:801 S HIGHWAY 78 STE 207
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4000
Mailing Address - Country:US
Mailing Address - Phone:214-422-1047
Mailing Address - Fax:
Practice Address - Street 1:820 E PRINCETON DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-9015
Practice Address - Country:US
Practice Address - Phone:972-734-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center