Provider Demographics
NPI:1023069739
Name:COLUMBIA MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP
Entity type:Organization
Organization Name:COLUMBIA MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-420-1556
Mailing Address - Street 1:1 PARK PLZ
Mailing Address - Street 2:REGULATORY COMPLIANCE SUPPORT, BLDG. 2-3 W
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6527
Mailing Address - Country:US
Mailing Address - Phone:469-420-7602
Mailing Address - Fax:972-420-1073
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3641
Practice Address - Country:US
Practice Address - Phone:469-420-7602
Practice Address - Fax:972-420-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094192401Medicaid