Provider Demographics
NPI:1770936858
Name:MEDICAL CITY DALLAS
Entity type:Organization
Organization Name:MEDICAL CITY DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEHIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:MUSTAFA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:469-441-8556
Mailing Address - Street 1:2521 GREEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-6433
Mailing Address - Country:US
Mailing Address - Phone:469-441-8556
Mailing Address - Fax:
Practice Address - Street 1:2521 GREEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-6433
Practice Address - Country:US
Practice Address - Phone:469-441-8556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38126282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital