=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366822447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2015
-----------------------------------------------------
Last Update Date | 09/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6200 W PARKER RD
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-8185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-981-8079
-----------------------------------------------------
Fax | 972-981-8111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 910156
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75391-0156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-236-3576
-----------------------------------------------------
Fax | 682-236-4608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | JOSHUA FLOREN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-981-8122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0404X
-----------------------------------------------------
Taxonomy Name | Cardiac Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | 000664
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------