MEDICARE: PRESBYTERIAN HOSPITAL OF DALLAS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	DT07657	TX

General Provider Information

NPI Number	:	1326253923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN HOSPITAL OF DALLAS

Provider Business Mailing Address
First Line	:	8200 WALNUT HILL LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4426
Country	:	US
Telephone Number	:	214-608-2008
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 WALNUT HILL LANE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4496
Country	:	US
Telephone Number	:	214-345-7413
Fax Number	:

Authorized Official
Title or Position	:	BILLING
Name	:	JERRY L BOSSBACH
Credential	:
Telephone Number	:	214345707086

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	11/11/2020

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