Provider Demographics
NPI:1316505043
Name:ETHICUS HOSPITAL DFW LLC
Entity type:Organization
Organization Name:ETHICUS HOSPITAL DFW LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-216-6285
Mailing Address - Street 1:1401 E TRINITY MILLS RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1442
Mailing Address - Country:US
Mailing Address - Phone:817-421-1066
Mailing Address - Fax:817-507-1800
Practice Address - Street 1:1401 E TRINITY MILLS RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1442
Practice Address - Country:US
Practice Address - Phone:972-810-0700
Practice Address - Fax:626-800-3974
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ETHICUS HOSPITAL DFW, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-29
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical