NPIViewer - Provider NPI 1689628984

NPI:	1689628984
Name:	COLUMBIA HOSPITAL AT MEDICAL CITY DALLAS SUBSIDIARY LP
Entity type:	Organization
Organization Name:	COLUMBIA HOSPITAL AT MEDICAL CITY DALLAS SUBSIDIARY LP
Other - Org Name:	<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:	CFO
Authorized Official - Prefix:
Authorized Official - First Name:	SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:	ANDERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	972-566-6225
Mailing Address - Street 1:	7777 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:	DALLAS
Mailing Address - State:	TX
Mailing Address - Zip Code:	75230-2505
Mailing Address - Country:	US
Mailing Address - Phone:	972-566-7000
Mailing Address - Fax:	972-566-6248
Practice Address - Street 1:	7777 FOREST LN
Practice Address - Street 2:
Practice Address - City:	DALLAS
Practice Address - State:	TX
Practice Address - Zip Code:	75230-2505
Practice Address - Country:	US
Practice Address - Phone:	972-566-7000
Practice Address - Fax:	972-566-6248
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2006-05-20
Last Update Date:	2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital
No	261QA1903X	Ambulatory Health Care Facilities	Clinic/Center	Ambulatory Surgical

State	Identifier ID	ID Type	Issuer
MO	016838005	Medicaid
KS	100299410A	Medicaid
KY	01600873	Medicaid
NY	01818831	Medicaid
WY	119325200	Medicaid
AL	HOS0647N	Medicaid
GA	000953862X	Medicaid
SD	0131580	Medicaid
MS	01401615	Medicaid
VT	0450647	Medicaid
IN	100380160A	Medicaid
OH	2458942	Medicaid
WA	3018488	Medicaid
NM	A5981	Medicaid
LA	1700622	Medicaid
CA	XHSP33559	Medicaid
ND	01614	Medicaid
NE	10024974100	Medicaid
AR	116539105	Medicaid
NC	4500647	Medicaid
FL	907716200	Medicaid
MN	023366800	Medicaid
IA	0570044	Medicaid
NJ	6170307	Medicaid
CO	95015236	Medicaid
TX	020943901	Medicaid
OK	100697860A	Medicaid
	166006500	Other	DEPT OF LABOR
AZ	407355	Medicaid
TX	HH0706	Other	BLUE CROSS
KY	01600873	Medicaid
TX	020943901	Medicaid
NM	A5981	Medicaid