Provider Demographics
NPI:1720362502
Name:UT SOUTHWESTERN MEDICAL CENTER
Entity Type:Organization
Organization Name:UT SOUTHWESTERN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, NEUROSURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:DUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-648-6727
Mailing Address - Street 1:5161 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7707
Mailing Address - Country:US
Mailing Address - Phone:214-648-7850
Mailing Address - Fax:214-648-2204
Practice Address - Street 1:5303 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-8855
Practice Address - Country:US
Practice Address - Phone:214-645-2300
Practice Address - Fax:214-645-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589350261QA1903X, 275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit