Provider Demographics
NPI:1992835573
Name:CITY OF DALLAS EHS
Entity Type:Organization
Organization Name:CITY OF DALLAS EHS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ELIGIBILITY CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALDIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-670-0559
Mailing Address - Street 1:1500 MARILLA DR
Mailing Address - Street 2:7 AN
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-6318
Mailing Address - Country:US
Mailing Address - Phone:214-670-0559
Mailing Address - Fax:214-670-8991
Practice Address - Street 1:4500 SPRING AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75210-1350
Practice Address - Country:US
Practice Address - Phone:214-670-0559
Practice Address - Fax:214-670-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1379331-02Medicaid