Provider Demographics
NPI:1255542122
Name:GREATER DALLAS HEALTHCARE ENTERPRISES
Entity type:Organization
Organization Name:GREATER DALLAS HEALTHCARE ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIR, ADMINISTR 501A, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2000
Mailing Address - Street 1:PO BOX 840711
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0711
Mailing Address - Country:US
Mailing Address - Phone:972-463-4313
Mailing Address - Fax:972-463-4245
Practice Address - Street 1:1445 ROSS AVE STE 1400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75202-2703
Practice Address - Country:US
Practice Address - Phone:469-893-6465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193143801Medicaid
TX193143801Medicaid
00Z195Medicare PIN