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General NPI Number Information
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NPI Number | 1538345350
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Entity Type | Organization
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Legal Business Name | GULF STATES LTAC OF DALLAS SOUTH LLC
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 2700 WALKER WAY
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City | DESOTO
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State | TX
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Zip | 75115-2089
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Country | US
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Telephone | 225-906-4006
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Fax | 225-906-4042
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Provider Business Mailing Address
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Address Line | 2700 WALKER WAY
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City | DESOTO
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State | TX
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Zip | 75115-2089
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Country | US
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Telephone | 972-298-1580
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Fax | 972-298-1578
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Authorized Official
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Title or Position | PRESIDENT AND COO
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Name | MR. EUGENE E. SMITH
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Credential |
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Telephone | 225-216-2299
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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 | 008748
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License Number State | TX
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