Basic Information
| Provider Information | |||||||||
| NPI: | 1518911833 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLUMBIA NORTH HILLS HOSPITAL SUBSIDIARY LP | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | MEDICAL CITY NORTH HILLS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 BOOTH CALLOWAY RD | ||||||||
| Address2: | |||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761807371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172551000 | ||||||||
| FaxNumber: | 8172844817 | ||||||||
| Practice Location | |||||||||
| Address1: | 4401 BOOTH CALLOWAY RD | ||||||||
| Address2: | |||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761807371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172551000 | ||||||||
| FaxNumber: | 8172844817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 06/02/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GALT | ||||||||
| AuthorizedOfficialFirstName: | NICK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8172551106 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 146609105 | 05 | AR | MEDICAID | 166013500 | 01 | DEPT OF LABOR | OTHER | HH0526 | 01 | BLUE CROSS | OTHER | 1702137 | 05 | LA | MEDICAID | 4500087 | 05 | NC | MEDICAID | 0131510 | 05 | SD | MEDICAID | 100419430A | 05 | KS | MEDICAID | 2458951 | 05 | OH | MEDICAID | 004500873 | 05 | VA | MEDICAID | 07659747 | 05 | MS | MEDICAID | 200350990A | 05 | IN | MEDICAID | 4101454 | 05 | MT | MEDICAID | 7204973 | 05 | MA | MEDICAID | 806496300 | 05 | ID | MEDICAID | 910696100 | 05 | FL | MEDICAID | 01544852 | 05 | NY | MEDICAID | 015691801 | 05 | MO | MEDICAID | 094105602 | 05 | TX | MEDICAID | 10024965500 | 05 | NE | MEDICAID | 100333 | 05 | OR | MEDICAID | 3024288 | 05 | WA | MEDICAID | 694324 | 05 | AZ | MEDICAID | 82190700 | 05 | WI | MEDICAID | 4674201 | 05 | MI | MEDICAID | 100697870A | 05 | OK | MEDICAID | NOR0087N | 05 | AL | MEDICAID | 30019199 | 01 | ENERGY DEPT | OTHER | XHSP33467 | 05 | CA | MEDICAID |