Provider Demographics
NPI:1205059813
Name:FRISCO LEBANON MEDICAL CENTER
Entity type:Organization
Organization Name:FRISCO LEBANON MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-899-6666
Mailing Address - Street 1:PO BOX 961213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-0213
Mailing Address - Country:US
Mailing Address - Phone:972-899-6650
Mailing Address - Fax:972-899-6665
Practice Address - Street 1:4851 LEGACY DR
Practice Address - Street 2:SUITE 301
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-0816
Practice Address - Country:US
Practice Address - Phone:214-618-6800
Practice Address - Fax:214-618-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care