Provider Demographics
NPI:1346602455
Name:CREEKSIDE FOREST MEDICAL CENTER
Entity Type:Organization
Organization Name:CREEKSIDE FOREST MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-899-6625
Mailing Address - Street 1:PO BOX 840795
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0795
Mailing Address - Country:US
Mailing Address - Phone:972-899-6625
Mailing Address - Fax:
Practice Address - Street 1:26306 KUYKENDAHL RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-1490
Practice Address - Country:US
Practice Address - Phone:346-331-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CHOICE EMERGENCY ROOM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-28
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160248261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX434148OtherJCAHO