Provider Demographics
NPI:1235495110
Name:COLUMBIA MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP
Entity Type:Organization
Organization Name:COLUMBIA MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP
Other - Org Name:MEDICAL CITY LEWISVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-420-1556
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3641
Mailing Address - Country:US
Mailing Address - Phone:972-420-1000
Mailing Address - Fax:972-420-1073
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3641
Practice Address - Country:US
Practice Address - Phone:972-420-1000
Practice Address - Fax:972-420-1073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-05
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
45T669Medicare Oscar/Certification