MEDICARE: CHILDREN'S HEALTH SYSTEM OF TEXAS

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	251E00000X	Home Health Agency
3	261QA1903X	Ambulatory Surgical Clinic/Center
4	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center
5	341600000X	Ambulance
6	3416A0800X	Air Ambulance
7	363L00000X	Nurse Practitioner
8	282NC2000X	Children's Hospital	000143	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	453302	OTHER	TX	MEDICARE

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

NPI Number	:	1194743013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S HEALTH SYSTEM OF TEXAS

Provider Business Mailing Address
First Line	:	1935 MEDICAL DISTRICT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7701
Country	:	US
Telephone Number	:	214-456-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 MEDICAL DISTRICT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7701
Country	:	US
Telephone Number	:	214-456-1900
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. ROBERT S FRIES
Credential	:
Telephone Number	:	214-456-7000

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	01/15/2024

1935 MEDICAL DISTRICT DR , HOSPITAL BASED @ CMC DALLAS
DALLAS, TX
75235-7701

Practice Phone: 214-456-6371
Practice Fax: 214-456-8132