Provider Demographics
NPI:1851382717
Name:RENAISSANCE HOSPITAL DALLAS
Entity Type:Organization
Organization Name:RENAISSANCE HOSPITAL DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UGHS
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-375-7000
Mailing Address - Street 1:2929 S. HAMPTON ROAD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224
Mailing Address - Country:US
Mailing Address - Phone:214-623-4400
Mailing Address - Fax:214-623-4850
Practice Address - Street 1:2929 S. HAMPTON ROAD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224
Practice Address - Country:US
Practice Address - Phone:214-623-4400
Practice Address - Fax:214-623-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100007282N00000X
TX100160282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216407101Medicaid
TX216407102Medicaid
TX216407101Medicaid