MEDICARE: DALLAS COUNTY HOSPITAL DISTRICT

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	314000000X	Skilled Nursing Facility		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

General Provider Information

NPI Number	:	1770972572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	7021 BRYANT IRVIN RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4243
Country	:	US
Telephone Number	:	817-361-1400
Fax Number	:	817-361-1400

Provider Business Practice Location Address
First Line	:	7021 BRYANT IRVIN RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4243
Country	:	US
Telephone Number	:	817-361-1400
Fax Number	:	817-361-1400

Authorized Official
Title or Position	:	CEO
Name	:	FREDERICK CERISE
Credential	:	MD
Telephone Number	:	214-590-8006

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	03/16/2017

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Directions to “DALLAS COUNTY HOSPITAL DISTRICT ” Practice Location

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