Basic Information
| Provider Information | |||||||||
| NPI: | 1073664116 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRESBYTERIAN HOSPITAL OF PLANO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 910156 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753910156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008906034 | ||||||||
| FaxNumber: | 6822360103 | ||||||||
| Practice Location | |||||||||
| Address1: | 6200 W PARKER RD | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750937939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729818079 | ||||||||
| FaxNumber: | 9729818111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | MINCHER | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VP REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 6822363013 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 000664 | TX | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | HH3865 | 01 | TX | PSYCH CHEM DEP | OTHER |