MEDICARE: GREATER DALLAS HEALTHCARE ENTERPRISES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	2085R0001X	Radiation Oncology Physician
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	207V00000X	Obstetrics & Gynecology 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

General Provider Information

NPI Number	:	1255542122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER DALLAS HEALTHCARE ENTERPRISES

Provider Business Mailing Address
First Line	:	PO BOX 840711
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-0711
Country	:	US
Telephone Number	:	972-463-4313
Fax Number	:	972-463-4245

Provider Business Practice Location Address
First Line	:	1445 ROSS AVE STE 1400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75202-2703
Country	:	US
Telephone Number	:	469-893-6465
Fax Number	:

Authorized Official
Title or Position	:	SR DIR, ADMINISTR 501A, TENET
Name	:	MR. ROBERT BRANSTETTER
Credential	:
Telephone Number	:	469-893-2000

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/21/2022

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Directions to “GREATER DALLAS HEALTHCARE ENTERPRISES ” Practice Location

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