Provider Demographics
NPI:1689031387
Name:GREATER DALLAS HEALTHCARE ENTERPRISES
Entity Type:Organization
Organization Name:GREATER DALLAS HEALTHCARE ENTERPRISES
Other - Org Name:PROVIDENCE MEDICAL PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP REGIONAL OPERATIONS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2563
Mailing Address - Street 1:PO BOX 840711
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0711
Mailing Address - Country:US
Mailing Address - Phone:915-881-3368
Mailing Address - Fax:915-751-0464
Practice Address - Street 1:9870 GATEWAY BLVD N
Practice Address - Street 2:STE. A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4425
Practice Address - Country:US
Practice Address - Phone:915-881-3368
Practice Address - Fax:915-751-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty