Provider Demographics
NPI:1326253923
Name:PRESBYTERIAN HOSPITAL OF DALLAS
Entity Type:Organization
Organization Name:PRESBYTERIAN HOSPITAL OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOSSBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:21434-570-7086
Mailing Address - Street 1:8200 WALNUT HILL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4426
Mailing Address - Country:US
Mailing Address - Phone:214-608-2008
Mailing Address - Fax:
Practice Address - Street 1:8200 WALNUT HILL LANE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4496
Practice Address - Country:US
Practice Address - Phone:214-345-7413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07657282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital