Provider Demographics
NPI:1912950114
Name:COLUMBIA MEDICAL CENTER OF ARLINGTON SUBSIDIARY LP
Entity Type:Organization
Organization Name:COLUMBIA MEDICAL CENTER OF ARLINGTON SUBSIDIARY LP
Other - Org Name:MEDICAL CITY ARLINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:ARDEMAGNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-472-4909
Mailing Address - Street 1:3301 MATLOCK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2908
Mailing Address - Country:US
Mailing Address - Phone:817-472-4909
Mailing Address - Fax:817-472-4878
Practice Address - Street 1:3301 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2908
Practice Address - Country:US
Practice Address - Phone:817-472-4909
Practice Address - Fax:817-472-4878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA MEDICAL CENTER OF ARLINGTON SUBSIDIARY LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120733403Medicaid
=========002OtherTRICARE - REHAB
45T675Medicare Oscar/Certification