MEDICARE: METHODIST HOSPITALS OF DALLAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0206X	Mammography Clinic/Center
2	261QS1200X	Sleep Disorder Diagnostic Clinic/Center
3	261QX0203X	Radiation Oncology Clinic/Center
4	273R00000X	Psychiatric Hospital Unit
5	261Q00000X	Clinic/Center
6	261QA1903X	Ambulatory Surgical Clinic/Center
7	261QM1300X	Multi-Specialty Clinic/Center
8	261QP2000X	Physical Therapy Clinic/Center
9	282N00000X	General Acute Care Hospital	100131	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033165501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METHODIST HOSPITALS OF DALLAS

Provider Business Mailing Address
First Line	:	PO BOX 911875
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-1875
Country	:	US
Telephone Number	:	469-204-1000
Fax Number	:	469-204-2016

Provider Business Practice Location Address
First Line	:	2831 E PRESIDENT GEORGE BUSH HWY
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-3561
Country	:	US
Telephone Number	:	469-204-1000
Fax Number	:	469-204-2016

Authorized Official
Title or Position	:	EXECUTIVE VP & CFO
Name	:	CRAIG ALLEN BJERKE
Credential	:
Telephone Number	:	214-947-4512

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	06/12/2024

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Directions to “METHODIST HOSPITALS OF DALLAS ” Practice Location

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