Provider Demographics
NPI:1093956070
Name:LTHM DALLAS - OPERATIONS LLC
Entity Type:Organization
Organization Name:LTHM DALLAS - OPERATIONS LLC
Other - Org Name:RENAISSANCE HOSPITAL - DALLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:SOILEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-886-1840
Mailing Address - Street 1:2929 S HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-3026
Mailing Address - Country:US
Mailing Address - Phone:214-623-4400
Mailing Address - Fax:214-623-4871
Practice Address - Street 1:2929 S HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-3026
Practice Address - Country:US
Practice Address - Phone:214-623-4400
Practice Address - Fax:214-623-4871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
67-0002Medicare PIN