Provider Demographics
NPI:1801826839
Name:BAYLOR SCOTT & WHITE MEDICAL CENTER - CENTENNIAL
Entity Type:Organization
Organization Name:BAYLOR SCOTT & WHITE MEDICAL CENTER - CENTENNIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-814-4801
Mailing Address - Street 1:PO BOX 840782
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0782
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12505 LEBANON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:972-963-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
TX100421282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200081880AMedicaid
946487740OtherAETNA US HEALTHCARE (NATI
TX169553801Medicaid
LA1707961Medicaid
17900-0009OtherPACIFICARE OF TEXAS (SECU
450885B000000OtherSECTION 1011
TX169553802Medicaid
000424OtherHUMANA
HH1048OtherBCBS OF TEXAS
450885B000000OtherSECTION 1011