Healthcare Provider Details

I. General information

NPI: 1689629941
Provider Name (Legal Business Name): METHODIST HOSPITALS OF DALLAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E BROAD ST
MANSFIELD TX
76063-5899
US

IV. Provider business mailing address

PO BOX 911875
DALLAS TX
75391-1875
US

V. Phone/Fax

Practice location:
  • Phone: 682-622-2000
  • Fax:
Mailing address:
  • Phone: 682-242-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: CRAIG ALLEN BJERKE
Title or Position: EXECUTIVE VP & CFO
Credential:
Phone: 214-947-4512