Provider Demographics
NPI:1568818417
Name:METHODIST HOSPITALS OF DALLAS
Entity Type:Organization
Organization Name:METHODIST HOSPITALS OF DALLAS
Other - Org Name:METHODIST SOUTHLAKE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BJERKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-947-4512
Mailing Address - Street 1:PO BOX 911875
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1875
Mailing Address - Country:US
Mailing Address - Phone:817-865-4500
Mailing Address - Fax:817-865-4850
Practice Address - Street 1:421 E STATE HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3635
Practice Address - Country:US
Practice Address - Phone:817-865-4400
Practice Address - Fax:817-865-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
670132OtherMEDICARE