1417010653 NPI number — UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS

Table of content: (NPI 1417010653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417010653 NPI number — UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS
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:
UT SOUTHWESTERN UNIVERSITY HOSPITAL - ZALE LIPSHY
Provider Other Organization Name Type Code:
3
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:
1417010653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 849927
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:
75284-9927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-645-4455
Provider Business Mailing Address Fax Number:
214-645-4500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5151 HARRY HINES BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75390-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-590-3172
Provider Business Practice Location Address Fax Number:
214-645-4500
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARNER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT FOR BUSINE
Authorized Official Telephone Number:
214-645-5476

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 022538501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 175289101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 175289102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 175289103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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