1508921313 NPI number — THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS

Table of content: (NPI 1508921313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508921313 NPI number — THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE 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:
Provider Other Organization Name Type Code:
6
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:
1508921313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 36423
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:
75235-9662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-645-4570
Provider Business Mailing Address Fax Number:
214-645-4578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6333 FOREST PARK ROAD
Provider Second Line Business Practice Location Address:
SUITE BLB 304
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75390-9279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-645-4570
Provider Business Practice Location Address Fax Number:
214-645-4578
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT FOR BUSINE
Authorized Official Telephone Number:
214-645-4570

Provider Taxonomy Codes

  • Taxonomy code: 347E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 009569 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: TPI175252901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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