Basic Information
| Provider Information | |||||||||
| NPI: | 1801826839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAYLOR SCOTT & WHITE MEDICAL CENTER - CENTENNIAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 840782 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752840782 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 12505 LEBANON RD | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729633333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 04/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | GEBHART | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4698144801 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 100421 | TX | Y | Hospitals | General Acute Care Hospital |
No ID Information.