DALLAS COUNTY HOSPITAL DISTRICT

Provider Demographics

• NPI: 1558308130
• Name: DALLAS COUNTY HOSPITAL DISTRICT
• Entity Type: Organization
• Organization Name: DALLAS COUNTY HOSPITAL DISTRICT
• Other - Org Name: YOUTH & FAMILY CENTERS
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
• Authorized Official - First Name: FREDERICK
• Authorized Official - Middle Name: P
• Authorized Official - Last Name: CERISE
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 214-590-8006
• Mailing Address - Street 1: PO BOX 660599
• Mailing Address - City: DALLAS
• Mailing Address - State: TX
• Mailing Address - Zip Code: 75266-0599
• Mailing Address - Country: US
• Practice Address - Street 1: 5151 MAPLE AVE FL 4
• Practice Address - City: DALLAS
• Practice Address - State: TX
• Practice Address - Zip Code: 75235-8136
• Practice Address - Country: US
• Practice Address - Phone: 214-266-1257
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-06-01
• Last Update Date: 2022-12-07

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
TX	080035102	Medicaid
TX	080035101	Medicaid
TX	080035103	Medicaid
TX	148767001	Medicaid
TX	148767002	Medicaid
TX	148793602	Medicaid
TX	148794401	Medicaid
TX	148766203	Medicaid
TX	148794402	Medicaid
TX	080035101	Medicaid
TX	149533501	Medicaid
TX	148881901	Medicaid
TX	148763902	Medicaid
TX	148881902	Medicaid
TX	080035103	Medicaid
TX	148763901	Medicaid
TX	148764701	Medicaid
TX	148764702	Medicaid
TX	148768801	Medicaid
TX	148793601	Medicaid