Provider Demographics
NPI:1932779220
Name:DALLAS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:DALLAS COUNTY HOSPITAL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-590-1852
Mailing Address - Street 1:5200 HARRY HINES BLVD
Mailing Address - Street 2:PHARMACY ADMINISTRATION
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7709
Mailing Address - Country:US
Mailing Address - Phone:214-590-8714
Mailing Address - Fax:
Practice Address - Street 1:3560 W CAMP WISDOM RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2506
Practice Address - Country:US
Practice Address - Phone:214-590-8714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DALLAS COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33818OtherTEXAS STATE BOARD OF PHARMACY LICENSE