Provider Demographics
NPI:1003868241
Name:METHODIST TRANSPLANT PHYSICIANS
Entity Type:Organization
Organization Name:METHODIST TRANSPLANT PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-947-4420
Mailing Address - Street 1:1411 N BECKLEY AVE
Mailing Address - Street 2:PAV III STE#268
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1259
Mailing Address - Country:US
Mailing Address - Phone:214-947-4400
Mailing Address - Fax:214-947-4404
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:PAV III STE#268
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1259
Practice Address - Country:US
Practice Address - Phone:214-947-4400
Practice Address - Fax:214-947-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y225OtherMEDICARE
TX156924602Medicaid
TX156924602Medicaid