Healthcare Provider Details

I. General information

NPI: 1821205840
Provider Name (Legal Business Name): HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 AUSTIN DR
DESOTO TX
75115-6605
US

IV. Provider business mailing address

605 AUSTIN DR
DESOTO TX
75115-6605
US

V. Phone/Fax

Practice location:
  • Phone: 972-230-0854
  • Fax:
Mailing address:
  • Phone: 972-230-0854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number581741
License Number StateTX

VIII. Authorized Official

Name: MRS. INGRID VANESSA CRAWFORD
Title or Position: RN
Credential:
Phone: 214-742-8387