MEDICARE: GREATER DALLAS HEALTHCARE ENTERPRISES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	208000000X	Pediatrics Physician
3	207V00000X	Obstetrics & Gynecology Physician

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	:	1952624074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER DALLAS HEALTHCARE ENTERPRISES

Provider Business Mailing Address
First Line	:	1445 ROSS AVE
Second Line	:	STE 1400
City	:	DALLAS
State	:	TX
Zip	:	75202-2711
Country	:	US
Telephone Number	:	469-893-6465
Fax Number	:

Provider Business Practice Location Address
First Line	:	4002 LOUETTA RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-4405
Country	:	US
Telephone Number	:	214-553-9009
Fax Number	:

Authorized Official
Title or Position	:	SR DIR, ADMINISTR 501A, TENET
Name	:	MR. ROBERT BRANSTETTER
Credential	:
Telephone Number	:	469-893-2000

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	06/08/2016

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Directions to “GREATER DALLAS HEALTHCARE ENTERPRISES ” Practice Location

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