MEDICARE: PINE CREEK MEDICAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	008182	TX

General Provider Information

NPI Number	:	1659374585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE CREEK MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	9032 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-1720
Country	:	US
Telephone Number	:	214-231-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	9032 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-1720
Country	:	US
Telephone Number	:	214-231-2273
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	LUCAS WILSON
Credential	:
Telephone Number	:	214-572-7132

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/30/2014

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Directions to “PINE CREEK MEDICAL CENTER LLC ” Practice Location

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