Provider Demographics
NPI:1669569984
Name:IRVING-COPPELL SURGICAL HOSPITAL LLP
Entity type:Organization
Organization Name:IRVING-COPPELL SURGICAL HOSPITAL LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-815-3665
Mailing Address - Street 1:400 W LYNDON B JOHNSON FWY STE 101B
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3718
Mailing Address - Country:US
Mailing Address - Phone:972-868-4000
Mailing Address - Fax:972-868-4009
Practice Address - Street 1:400 WEST I-635
Practice Address - Street 2:SUITE 101
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3842
Practice Address - Country:US
Practice Address - Phone:972-868-4000
Practice Address - Fax:972-868-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007995282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163936102Medicaid
TX163936101Medicaid
TX163936102Medicaid
TX450874Medicare Oscar/Certification