Provider Demographics
NPI:1417107061
Name:CITY OF DALLAS ENVIRONMENTAL & HEALTH SERVICES
Entity Type:Organization
Organization Name:CITY OF DALLAS ENVIRONMENTAL & HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:214-670-0505
Mailing Address - Street 1:1500 MARILLA
Mailing Address - Street 2:7AN
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-6318
Mailing Address - Country:US
Mailing Address - Phone:214-670-0505
Mailing Address - Fax:214-670-8991
Practice Address - Street 1:1500 MARILLA
Practice Address - Street 2:7AN
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-6318
Practice Address - Country:US
Practice Address - Phone:214-670-0505
Practice Address - Fax:214-670-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137933103Medicaid
TX137933105Medicaid
TX137933106Medicaid
TX137933102Medicaid
TX017587901Medicaid