MEDICARE: THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT 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	261QX0203X	Radiation Oncology Clinic/Center

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	:	1497720353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:	214-645-0624
Fax Number	:	214-645-0078

Provider Business Practice Location Address
First Line	:	5801 FOREST PARK RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-9183
Country	:	US
Telephone Number	:	214-645-0624
Fax Number	:	214-645-0078

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	BRUCE A. MEYER
Credential	:	M.D.
Telephone Number	:	214-648-0309

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	02/19/2013

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