Provider Demographics
NPI:1417010653
Name:UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS
Entity Type:Organization
Organization Name:UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS
Other - Org Name:UT SOUTHWESTERN UNIVERSITY HOSPITAL - ZALE LIPSHY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT FOR BUSINE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-645-5476
Mailing Address - Street 1:PO BOX 849927
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-9927
Mailing Address - Country:US
Mailing Address - Phone:214-645-4455
Mailing Address - Fax:214-645-4500
Practice Address - Street 1:5151 HARRY HINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9000
Practice Address - Country:US
Practice Address - Phone:214-590-3172
Practice Address - Fax:214-645-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX022538501Medicaid
TX175289101Medicaid
TX175289102Medicaid
TX175289103Medicaid
TX175289103Medicaid
TX175289101Medicaid
45T766Medicare Oscar/Certification
TX022538501Medicaid
TX175289102Medicaid