Provider Demographics
NPI:1275673972
Name:PRESBYTERIAN HOSPITAL OF DALLAS
Entity Type:Organization
Organization Name:PRESBYTERIAN HOSPITAL OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TERESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-345-5634
Mailing Address - Street 1:5750 PINELAND DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5300
Mailing Address - Country:US
Mailing Address - Phone:214-345-5634
Mailing Address - Fax:214-345-7046
Practice Address - Street 1:8200 WALNUT HILL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4426
Practice Address - Country:US
Practice Address - Phone:214-345-5634
Practice Address - Fax:214-345-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000431273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH0598OtherBLUE CROSS PSYCH IP