Provider Demographics
NPI:1992772008
Name:IRVING COPPELL SURGICAL HOSPITAL
Entity type:Organization
Organization Name:IRVING COPPELL SURGICAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:CHRISTI-ANN
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-868-4006
Mailing Address - Street 1:400 W LBJ FWY
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3707
Mailing Address - Country:US
Mailing Address - Phone:972-868-4000
Mailing Address - Fax:972-868-4009
Practice Address - Street 1:400 W LBJ FWY
Practice Address - Street 2:SUITE 101
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3707
Practice Address - Country:US
Practice Address - Phone:972-868-4000
Practice Address - Fax:972-868-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007995284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX450874Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER