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General NPI Number Information
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NPI Number | 1194984757
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Entity Type | Organization
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Legal Business Name | UT SOUTHWESTERN MEDICAL CENTER
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Dates
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Enumeration Date | 06/08/2008
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 5323 HARRY HINES BLVD
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City | DALLAS
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State | TX
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Zip | 75390-7201
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Country | US
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Telephone | 972-451-0617
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 845347
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City | DALLAS
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State | TX
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Zip | 75284-5347
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Country | US
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Telephone | 972-451-0617
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MR. WISAM NACHAWATI
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Credential | P.A.
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Telephone | 972-451-0617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | PA04785
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA04785
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License Number State | TX
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