Basic Information
Provider Information
NPI: 1003246919
EntityType: 2
ReplacementNPI:  
OrganizationName: STEPHENS MEMORIAL HOSPITAL DISTRICT
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Mailing Information
Address1: 5560 TENNYSON PKWY STE 210
Address2:  
City: PLANO
State: TX
PostalCode: 750243582
CountryCode: US
TelephoneNumber: 4699166100
FaxNumber: 4699166105
Practice Location
Address1: 230 S CLARK RD
Address2:  
City: CEDAR HILL
State: TX
PostalCode: 751042750
CountryCode: US
TelephoneNumber: 9722917877
FaxNumber: 9722931273
Other Information
ProviderEnumerationDate: 11/14/2013
LastUpdateDate: 11/08/2017
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: ALVAREZ
AuthorizedOfficialFirstName: MARY
AuthorizedOfficialMiddleName: M
AuthorizedOfficialTitleorPosition: BUSINESS OFFICE MANAGER
AuthorizedOfficialTelephone: 2545592241
IsSoleProprietor:  
IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X134812TXY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

ID Information
IDTypeStateIssuerDescription
00510105TX MEDICAID


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