Provider Demographics
NPI:1922002674
Name:FRISCO MEDICAL CENTER LLP
Entity type:Organization
Organization Name:FRISCO MEDICAL CENTER LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTENADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-407-5010
Mailing Address - Street 1:14201 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2916
Mailing Address - Country:US
Mailing Address - Phone:972-763-3859
Mailing Address - Fax:214-407-5004
Practice Address - Street 1:5601 WARREN PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4069
Practice Address - Country:US
Practice Address - Phone:214-407-5000
Practice Address - Fax:214-407-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2500X, 261QS1200X, 261QU0200X
TX007874282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1571440001Medicaid
TX157144001Medicaid
TXHH1015OtherBLUE CROSS BLUE SHIELD
TX1571440001Medicaid