Provider Demographics
NPI:1346306719
Name:CHILDREN'S MEDICAL CENTER OF DALLAS
Entity Type:Organization
Organization Name:CHILDREN'S MEDICAL CENTER OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:KATEB
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:972-378-5148
Mailing Address - Street 1:2209 BRADBURY CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4351
Mailing Address - Country:US
Mailing Address - Phone:972-378-5148
Mailing Address - Fax:
Practice Address - Street 1:1935 MOTOR ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX465211282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren