Provider Demographics
NPI:1659323772
Name:COLUMBIA PLAZA MEDICAL CENTER OF FORT WORTH SUBSIDIARY LP
Entity Type:Organization
Organization Name:COLUMBIA PLAZA MEDICAL CENTER OF FORT WORTH SUBSIDIARY LP
Other - Org Name:MEDICAL CITY FORT WORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-347-5862
Mailing Address - Street 1:900 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3902
Mailing Address - Country:US
Mailing Address - Phone:817-336-2100
Mailing Address - Fax:817-347-5796
Practice Address - Street 1:900 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3902
Practice Address - Country:US
Practice Address - Phone:817-336-2100
Practice Address - Fax:817-347-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI82203000Medicaid
166010000OtherDEPT OF LABOR
NJ0035441Medicaid
WY117678100Medicaid
TXHH0730OtherBLUE CROSS
OK200060080AMedicaid
NMB1659Medicaid
TX094193202Medicaid
OK200060080AMedicaid
TX094193202Medicaid