Provider Demographics
NPI:1033165501
Name:METHODIST HOSPITALS OF DALLAS
Entity Type:Organization
Organization Name:METHODIST HOSPITALS OF DALLAS
Other - Org Name:METHODIST RICHARDSON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BJERKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-947-4512
Mailing Address - Street 1:PO BOX 911875
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1875
Mailing Address - Country:US
Mailing Address - Phone:469-204-1000
Mailing Address - Fax:469-204-2016
Practice Address - Street 1:2831 E PRESIDENT GEORGE BUSH HWY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3561
Practice Address - Country:US
Practice Address - Phone:469-204-1000
Practice Address - Fax:469-204-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QM1300X, 261QP2000X, 261QR0206X, 261QS1200X, 261QX0203X, 273R00000X
TX100131282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209345201Medicaid
TX209345202Medicaid
TXCC8984Medicare PIN
TX00R08TMedicare PIN
TX209345202Medicaid
TX45S537Medicare Oscar/Certification