MEDICARE: DALLAS COUNTY HOSPITAL DISTRICT

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	363LP0200X	Pediatric Nurse Practitioner
2	208000000X	Pediatrics Physician

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093754475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 660599
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0599
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 MAPLE AVE # 6B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-8136
Country	:	US
Telephone Number	:	214-266-0110
Fax Number	:	214-266-0113

Authorized Official
Title or Position	:	PRESIDENT & CHIEF EXECUTIVE OFFICER
Name	:	FREDRICK P. CERISE
Credential	:	M.D.
Telephone Number	:	214-590-8006

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/10/2023

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Directions to “DALLAS COUNTY HOSPITAL DISTRICT ” Practice Location

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