Healthcare Provider Details

I. General information

NPI: 1689068355
Provider Name (Legal Business Name): PLANO SPECIALTY HOSPITAL OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 COIT RD
PLANO TX
75075-6141
US

IV. Provider business mailing address

111 CLIFTON AVE
LAKEWOOD NJ
08701-3342
US

V. Phone/Fax

Practice location:
  • Phone: 972-596-7930
  • Fax:
Mailing address:
  • Phone: 214-396-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number100319
License Number StateTX

VIII. Authorized Official

Name: JOE NEUMAN
Title or Position: CEO
Credential:
Phone: 214-396-3482