Provider Demographics
NPI:1205999232
Name:HICKORY TRAIL HOSPITAL, L.P.
Entity type:Organization
Organization Name:HICKORY TRAIL HOSPITAL, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SRVP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-678-3300
Mailing Address - Street 1:2000 OLD HICKORY TRL
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2242
Mailing Address - Country:US
Mailing Address - Phone:972-298-7323
Mailing Address - Fax:972-709-0581
Practice Address - Street 1:2000 OLD HICKORY TRL
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2242
Practice Address - Country:US
Practice Address - Phone:972-298-7323
Practice Address - Fax:972-709-0581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008378283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184076101Medicaid
454065Medicare Oscar/Certification