MEDICARE: PRESTON HOLLOW EMERGENCY ROOM

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	261QE0002X	Emergency Care Clinic/Center

General Provider Information

NPI Number	:	1356740534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTON HOLLOW EMERGENCY ROOM

Provider Business Mailing Address
First Line	:	8007 WALNUT HILL LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4313
Country	:	US
Telephone Number	:	214-217-0911
Fax Number	:	214-217-0915

Provider Business Practice Location Address
First Line	:	8007 WALNUT HILL LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4313
Country	:	US
Telephone Number	:	214-217-0911
Fax Number	:	214-217-0915

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JENNIFER LANZA
Credential	:	R.N.
Telephone Number	:	214-217-0911

Provider Enumeration Date	:	08/14/2014
Last Update Date	:	08/14/2014

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