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NPI Code Detail

MEDICARE: GULF STATES LTAC OF DALLAS SOUTH LLC

MEDICARE: GULF STATES LTAC OF DALLAS SOUTH LLC
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
1282N00000XGeneral Acute Care Hospital008748TX

General Provider Information

NPI Number : 1538345350
Entity Type Code : Organization
Provider Name (Legal Business Name) : GULF STATES LTAC OF DALLAS SOUTH LLC
Provider Business Mailing Address
First Line : 2700 WALKER WAY
Second Line :
City : DESOTO
State : TX
Zip : 75115-2089
Country : US
Telephone Number : 972-298-1580
Fax Number : 972-298-1578
Provider Business Practice Location Address
First Line : 2700 WALKER WAY
Second Line :
City : DESOTO
State : TX
Zip : 75115-2089
Country : US
Telephone Number : 225-906-4006
Fax Number : 225-906-4042
Authorized Official
Title or Position : PRESIDENT AND COO
Name : MR. EUGENE E. SMITH
Credential :
Telephone Number : 225-216-2299
Provider Enumeration Date : 01/10/2008
Last Update Date : 02/11/2009

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Directions to “GULF STATES LTAC OF DALLAS SOUTH LLC ” Practice Location

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