Provider Demographics
NPI:1649273434
Name:BAYLOR REGIONAL MEDICAL CENTER AT PLANO
Entity type:Organization
Organization Name:BAYLOR REGIONAL MEDICAL CENTER AT PLANO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:GARISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-814-3176
Mailing Address - Street 1:PO BOX 849829
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-9829
Mailing Address - Country:US
Mailing Address - Phone:214-820-6710
Mailing Address - Fax:214-820-7950
Practice Address - Street 1:4700 ALLIANCE BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5323
Practice Address - Country:US
Practice Address - Phone:469-814-2000
Practice Address - Fax:469-814-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008140282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171848801Medicaid
TX284511OtherAMERICAID
TX284511OtherAMERICAID
TX450890Medicare Oscar/Certification