Basic Information
| Provider Information | |||||||||
| NPI: | 1427340728 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PLAZA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10100 TANTARRA DR | ||||||||
| Address2: | |||||||||
| City: | BURLESON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760287856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179929390 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761043902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173362100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2011 | ||||||||
| LastUpdateDate: | 05/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | ROBYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PA-C | ||||||||
| AuthorizedOfficialTelephone: | 8179929390 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | PA05854 | TX | Y | Hospitals | General Acute Care Hospital |
No ID Information.