Healthcare Provider Details

I. General information

NPI: 1568668226
Provider Name (Legal Business Name): PRESBYTERIAN HOSPITAL OF DALLAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E PARK BLVD SUITE 100
PLANO TX
75074-5465
US

IV. Provider business mailing address

5750 PINELAND DR SUITE 140
DALLAS TX
75231-5300
US

V. Phone/Fax

Practice location:
  • Phone: 214-345-5634
  • Fax: 214-345-5704
Mailing address:
  • Phone: 214-345-5634
  • Fax: 214-345-7046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number000431
License Number StateTX

VIII. Authorized Official

Name: MR. MARK TERESI
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 214-345-5634