Provider Demographics
NPI:1689068355
Name:PLANO SPECIALTY HOSPITAL OPERATOR LLC
Entity Type:Organization
Organization Name:PLANO SPECIALTY HOSPITAL OPERATOR LLC
Other - Org Name:PLANO SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-396-3482
Mailing Address - Street 1:111 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3342
Mailing Address - Country:US
Mailing Address - Phone:214-396-3482
Mailing Address - Fax:
Practice Address - Street 1:1621 COIT RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6141
Practice Address - Country:US
Practice Address - Phone:972-596-7930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X, 282E00000X
TX100319282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX353871201Medicaid
TX452054Medicare Oscar/Certification