MEDICARE: COUNTY 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	208000000X	Pediatrics Physician
2	251K00000X	Public Health or Welfare Agency
3	261QM2500X	Medical Specialty Clinic/Center
4	261QP0905X	State or Local Public Health Clinic/Center
5	261QR0200X	Radiology Clinic/Center	R11347	TX
6	291U00000X	Clinical Medical Laboratory	45D0672012	TX
7	2083P0901X	Public Health & General Preventive Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740227495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF DALLAS

Provider Business Mailing Address
First Line	:	2377 N STEMMONS FWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75207-2710
Country	:	US
Telephone Number	:	214-819-2109
Fax Number	:	214-819-2107

Provider Business Practice Location Address
First Line	:	2377 N STEMMONS FWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75207-2710
Country	:	US
Telephone Number	:	214-819-1819
Fax Number	:	214-819-6057

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. ZACHARY THOMPSON
Credential	:
Telephone Number	:	214-819-2101

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	11/14/2013

Similar Medicare Providers

1255441424 — MR. GARRY WOO M.D.
Practice Location Address:

2377 N STEMMONS FWY , SUITE 301
DALLAS, TX
75207-2710

Practice Phone: 214-819-2057
Practice Fax:

1215006317 — DR. KARINE R LANCASTER M.D.
Practice Location Address:

2377 N STEMMONS FWY , 512
DALLAS, TX
75207-2710

Practice Phone: 214-819-6052
Practice Fax: 214-819-2107

1891852208 — LINDA M. NORMAN WHNP-BC
Practice Location Address:

2377 N STEMMONS FWY , SUITE 336
DALLAS, TX
75207-2710

Practice Phone: 214-819-6522
Practice Fax: 214-819-1981

1740471960 — DR. KENNY LANE BOWMAN D.O.
Practice Location Address:

2710 N STEMMONS FWY (MAXIM PHYSICIAN RESOURCES) , SUITE 100, NORTH TOWER
DALLAS, TX
75207-2210

Practice Phone: 888-800-1853
Practice Fax: 214-741-0701

1518132042 — DR. PHILIP PO-WEN HUANG M.D.
Practice Location Address:

2377 N STEMMONS FWY
DALLAS, TX
75207-2710

Practice Phone: 214-819-2014
Practice Fax:

1447489984 — DR. SAMUEL SOO AHN D.C.
Practice Location Address:

2710 N STEMMONS FWY , SUITE 101
DALLAS, TX
75207-2210

Practice Phone: 214-905-4999
Practice Fax: 214-905-4999

Directions to “COUNTY OF DALLAS ” Practice Location

Language	Start Address	Practice Location

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