# EBD BEMC BURLESON, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Baylor Scott & White Emergency Hospital Grand Prairie
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831629526
- **Authorized official:** TINA JOHNSON (SR PROVIDER ENROLLMENT COORDINATOR)
- **Authorized official phone:** (713) 929-2076

## Contact information

- **Practice address:** 3095 KINGSWOOD BLVD, SUITE 100, GRAND PRAIRIE, TX 75052
- **Practice address phone:** (713) 637-1146
- **Mailing address:** 8686 NEW TRAILS DR STE 100, THE WOODLANDS, TX 77381-1176
- **Mailing address phone:** (713) 637-1146
- **Mailing address fax:** (281) 298-5311

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | — |
| 282N00000X | General Acute Care Hospital | — | NULL | Yes |

## Other

- **Enumeration date:** 06/14/2017
- **Last updated:** 05/10/2024