MEDICARE: UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207YP0228X	Pediatric Otolaryngology Physician
2	2080P0202X	Pediatric Cardiology Physician
3	2080P0206X	Pediatric Gastroenterology Physician
4	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician
5	2086S0120X	Pediatric Surgery Physician
6	2088P0231X	Pediatric Urology Physician
7	231H00000X	Audiologist
8	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1053832253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS

Provider Business Mailing Address
First Line	:	6363 FOREST PARK RD SUITE BL3 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-9087
Country	:	US
Telephone Number	:	214-648-3111
Fax Number	:	214-645-0078

Provider Business Practice Location Address
First Line	:	1935 MEDICAL DISTRICT DRIVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235
Country	:	US
Telephone Number	:	214-456-7000
Fax Number	:

Authorized Official
Title or Position	:	CFO - UNIVERSITY HOSPITAL
Name	:	MARK ALAN MEYER
Credential	:
Telephone Number	:	214-633-4804

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	01/18/2023

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Directions to “UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS ” Practice Location

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