Provider Demographics
NPI:1821523648
Name:UNIVERSITY OF TEXAS SOUTHWESTERN
Entity Type:Organization
Organization Name:UNIVERSITY OF TEXAS SOUTHWESTERN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRY PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-648-0860
Mailing Address - Street 1:UTSW DEPARTMENT OF PSYCHIATRY
Mailing Address - Street 2:5323 HARRY HINES BLVD, SUITE NC5.804
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UTSW DEPARTMENT OF PSYCHIATRY
Practice Address - Street 2:5323 HARRY HINES BLVD, SUITE NC5.804
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-0001
Practice Address - Country:US
Practice Address - Phone:214-648-7012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital