1225437684 NPI number — GREATER DALLAS HEALTHCARE ENTERPRISES

Table of content: (NPI 1225437684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225437684 NPI number — GREATER DALLAS HEALTHCARE ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER DALLAS HEALTHCARE ENTERPRISES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225437684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 840711
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-0711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-826-6005
Provider Business Mailing Address Fax Number:
214-826-6012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9540 GARLAND RD
Provider Second Line Business Practice Location Address:
STE. 410
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75218-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-826-6005
Provider Business Practice Location Address Fax Number:
214-826-6012
Provider Enumeration Date:
08/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BRANSTETTER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
SR DIR, ADMINISTR 501A, TENET
Authorized Official Telephone Number:
469-893-2000

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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