Provider Demographics
NPI:1487606596
Name:COLUMBIA HOSPITAL AT MEDICAL CITY DALLAS SUBSIDIARY LP
Entity type:Organization
Organization Name:COLUMBIA HOSPITAL AT MEDICAL CITY DALLAS SUBSIDIARY LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHREEVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-566-6225
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-7000
Mailing Address - Fax:972-566-6248
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-7000
Practice Address - Fax:972-566-6248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA HOSPITAL AT MEDICAL CITY DALLAS SUBSIDIARY LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========002OtherTRICARE REHAB
45T647Medicare Oscar/Certification