Provider Demographics
NPI:1518021476
Name:TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS
Entity Type:Organization
Organization Name:TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-345-2815
Mailing Address - Street 1:500 E BORDER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-7445
Mailing Address - Country:US
Mailing Address - Phone:214-345-7260
Mailing Address - Fax:682-236-4620
Practice Address - Street 1:8440 WALNUT HILL LN
Practice Address - Street 2:SUITE 540
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3833
Practice Address - Country:US
Practice Address - Phone:214-345-5634
Practice Address - Fax:214-345-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000431208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080307401Medicaid