Provider Demographics
NPI:1417128505
Name:DALLAS INSTITUTE OF ADVANCED MEDICINE INC.
Entity Type:Organization
Organization Name:DALLAS INSTITUTE OF ADVANCED MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBAR-VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-339-9350
Mailing Address - Street 1:DALLAS INSTITUTE OF ADVANCED MEDICINE INC6
Mailing Address - Street 2:P.O. BOX 9236
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-9236
Mailing Address - Country:US
Mailing Address - Phone:214-339-9350
Mailing Address - Fax:214-331-9164
Practice Address - Street 1:2909 S HAMPTON RD
Practice Address - Street 2:SUITE F- 122, LOCK BOX 29
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-3000
Practice Address - Country:US
Practice Address - Phone:214-339-9350
Practice Address - Fax:214-331-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1085261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF41259Medicare UPIN