1528081429 NPI number — VISTA HOSPITAL OF DALLAS

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 1528081429 NPI number — VISTA HOSPITAL OF DALLAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISTA HOSPITAL OF 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:
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:
1528081429
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX DEPT 802-3 4346
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77210-4346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-378-3000
Provider Business Mailing Address Fax Number:
713-378-3104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2696 W WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75042-6441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-378-3000
Provider Business Practice Location Address Fax Number:
713-378-3104
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PHAM
Authorized Official First Name:
JACQUELYN
Authorized Official Middle Name:
N
Authorized Official Title or Position:
FINANCIAL BUSINESS SERVICES DIRECTO
Authorized Official Telephone Number:
713-378-3000

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  000359 , 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: 175011901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH1047 . This is a "BCBS #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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