1518485721 NPI number — GREATER DALLAS HEALTHCARE ENTERPRISES

Table of content: MISS DEIRDRE MARIE KEANE N.P. (NPI 1982064663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518485721 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:
1518485721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2017
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:
936-205-5806
Provider Business Mailing Address Fax Number:
936-205-5914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2702 N UNIVERSITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NACOGDOCHES
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75965-2922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-205-5806
Provider Business Practice Location Address Fax Number:
936-205-5914
Provider Enumeration Date:
09/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMAS
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP REGIONAL OPERATIONS, TENET
Authorized Official Telephone Number:
469-893-2563

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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