Provider Demographics
NPI:1881654903
Name:METHODIST HOSPTIAL OF DALLAS
Entity Type:Organization
Organization Name:METHODIST HOSPTIAL OF DALLAS
Other - Org Name:PHYSICIANS EMERGENCY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP & CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-947-4510
Mailing Address - Street 1:4040 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3158
Mailing Address - Country:US
Mailing Address - Phone:214-520-5700
Mailing Address - Fax:214-520-5794
Practice Address - Street 1:1441 N BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1201
Practice Address - Country:US
Practice Address - Phone:214-947-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0064BHOtherBLUE CROSS BLUE SHIELD TX
TX080937801Medicaid
TX0064BHOtherBLUE CROSS BLUE SHIELD TX