Healthcare Provider Details

I. General information

NPI: 1417132127
Provider Name (Legal Business Name): NORTH TEXAS HEALTH CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD # 11K
DALLAS TX
75216-7167
US

IV. Provider business mailing address

4500 S LANCASTER RD # 11K
DALLAS TX
75216-7167
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-1270
  • Fax: 214-302-1358
Mailing address:
  • Phone: 214-857-1270
  • Fax: 214-302-1358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. CLYDE LOUIS DEERE
Title or Position: RECREATION THERAPIST
Credential:
Phone: 214-857-1134