Provider Demographics
NPI:1982609558
Name:TROPHY CLUB MEDICAL CENTER LP
Entity Type:Organization
Organization Name:TROPHY CLUB MEDICAL CENTER LP
Other - Org Name:BAYLOR SCOTT & WHITE MEDICAL CENTER - TROPHY CLUB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-343-0832
Mailing Address - Street 1:2850 E STATE HIGHWAY 114
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5302
Mailing Address - Country:US
Mailing Address - Phone:817-837-4600
Mailing Address - Fax:817-837-4610
Practice Address - Street 1:2850 E STATE HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262
Practice Address - Country:US
Practice Address - Phone:817-837-4600
Practice Address - Fax:817-837-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008051282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX450883Medicare PIN