Basic Information
Provider Information | |||||||||
NPI: | 1396779948 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 910115 | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 753910115 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8008906034 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 8200 WALNUT HILL LANE | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752314426 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2143455634 | ||||||||
FaxNumber: | 2143457046 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/10/2006 | ||||||||
LastUpdateDate: | 04/22/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MINCHER | ||||||||
AuthorizedOfficialFirstName: | JEFF | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | SENIOR VP REVENUE CYCLE | ||||||||
AuthorizedOfficialTelephone: | 6822363013 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/22/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 000431 | TX | N |   | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 282N00000X | 000431 | TX | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | 025249601 | 05 | TX |   | MEDICAID | 0209082-04 | 01 | TX | MEDICAID HASCO | OTHER | 020908201 | 05 | TX |   | MEDICAID | 022833001 | 05 | TX |   | MEDICAID | HH0598 | 01 | TX | BLUE CROSS | OTHER | HOHH059801 | 01 | TX | BCBS | OTHER |