Basic Information
| Provider Information | |||||||||
| NPI: | 1710924832 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLUMBIA PLAZA MEDICAL CENTER OF FORT WORTH SUBSIDIARY LP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEDICAL CITY FORT WORTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761043902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173362100 | ||||||||
| FaxNumber: | 8173475796 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761043902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173362100 | ||||||||
| FaxNumber: | 8173475796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 11/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | THOMSON | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8173475862 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | Y | Hospital Units | Rehabilitation Unit |
No ID Information.