1821523648 NPI number — UNIVERSITY OF TEXAS SOUTHWESTERN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821523648 NPI number — UNIVERSITY OF TEXAS SOUTHWESTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF TEXAS SOUTHWESTERN
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:
1821523648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UTSW DEPARTMENT OF PSYCHIATRY
Provider Second Line Business Mailing Address:
5323 HARRY HINES BLVD, SUITE NC5.804
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75390-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UTSW DEPARTMENT OF PSYCHIATRY
Provider Second Line Business Practice Location Address:
5323 HARRY HINES BLVD, SUITE NC5.804
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75390-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-648-7012
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
TAMEKA
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHIATRY PROGRAM COORDINATOR
Authorized Official Telephone Number:
214-648-0860

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)





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