Provider Demographics
NPI:1699976852
Name:ETHICUS HOSPITAL-GRAPEVINE, LP
Entity type:Organization
Organization Name:ETHICUS HOSPITAL-GRAPEVINE, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-288-1314
Mailing Address - Street 1:4201 WILLIAM D TATE
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-288-1314
Mailing Address - Fax:817-288-1499
Practice Address - Street 1:4201 WILLIAM D TATE
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:817-288-1314
Practice Address - Fax:817-288-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
670042Medicare Oscar/Certification