MEDICARE: BARIATRIC CENTER 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

General Provider Information

NPI Number	:	1710007927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARIATRIC CENTER OF DALLAS

Provider Business Mailing Address
First Line	:	PO BOX 181623
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-8623
Country	:	US
Telephone Number	:	972-270-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2696 W WALNUT ST
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75042-6441
Country	:	US
Telephone Number	:	972-270-4800
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	DANA D LACKEY
Credential	:
Telephone Number	:	972-270-4800

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	08/22/2020

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