Provider Demographics
NPI:1811142359
Name:METHODIST HOSPITALS OF DALLAS
Entity type:Organization
Organization Name:METHODIST HOSPITALS OF DALLAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BJERKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-947-4512
Mailing Address - Street 1:PO BOX 911875
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1875
Mailing Address - Country:US
Mailing Address - Phone:469-204-6900
Mailing Address - Fax:469-204-6906
Practice Address - Street 1:401 W CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3416
Practice Address - Country:US
Practice Address - Phone:972-498-4000
Practice Address - Fax:972-498-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000549273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020921501Medicaid
TX45S537Medicare Oscar/Certification
TXCC8984Medicare PIN