Provider Demographics
NPI:1992742019
Name:COLUMBIA PLAZA MEDICAL CENTER OF FORT WORTH SUBSIDIARY LP
Entity type:Organization
Organization Name:COLUMBIA PLAZA MEDICAL CENTER OF FORT WORTH SUBSIDIARY LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-347-5862
Mailing Address - Street 1:900 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3902
Mailing Address - Country:US
Mailing Address - Phone:817-336-2100
Mailing Address - Fax:817-347-5796
Practice Address - Street 1:900 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3902
Practice Address - Country:US
Practice Address - Phone:817-336-2100
Practice Address - Fax:817-347-5796
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA PLAZA MEDICAL CENTER OF FORT WORTH SUBSIDIARY LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-31
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094193201Medicaid