Basic Information
| Provider Information | |||||||||
| NPI: | 1134226616 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DFW 5.01 (A) CORPORATION | ||||||||
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| OtherOrganizationName: | MARY SHIELS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14275 MIDWAY ROAD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149328234 | ||||||||
| FaxNumber: | 2149328284 | ||||||||
| Practice Location | |||||||||
| Address1: | 3515 HOWELL STREET | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724049345 | ||||||||
| FaxNumber: | 9724042506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DILLEMUTH | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT TREASURY | ||||||||
| AuthorizedOfficialTelephone: | 5617126242 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.