MEDICARE: VISTA HOSPITAL OF 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	282N00000X	General Acute Care Hospital	000359	TX

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	HH1047	OTHER	TX	BCBS #

General Provider Information

NPI Number	:	1528081429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA HOSPITAL OF DALLAS

Provider Business Mailing Address
First Line	:	PO BOX DEPT 802-3 4346
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77210-4346
Country	:	US
Telephone Number	:	713-378-3000
Fax Number	:	713-378-3104

Provider Business Practice Location Address
First Line	:	2696 W WALNUT ST
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75042-6441
Country	:	US
Telephone Number	:	713-378-3000
Fax Number	:	713-378-3104

Authorized Official
Title or Position	:	FINANCIAL BUSINESS SERVICES DIRECTO
Name	:	MS. JACQUELYN N PHAM
Credential	:
Telephone Number	:	713-378-3000

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	02/03/2009

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