Provider Demographics
NPI:1689629941
Name:METHODIST HOSPITALS OF DALLAS
Entity Type:Organization
Organization Name:METHODIST HOSPITALS OF DALLAS
Other - Org Name:METHODIST MANSFIELD 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:682-242-2000
Mailing Address - Fax:
Practice Address - Street 1:2700 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5899
Practice Address - Country:US
Practice Address - Phone:682-622-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186221101Medicaid
TX186221102OtherMEDICAID HASCO NUMBER