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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1992463871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 660599
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0599
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 UNIVERSITY HILLS BLVD STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-1219
Country	:	US
Telephone Number	:	214-590-0153
Fax Number	:

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

Provider Enumeration Date	:	12/07/2021
Last Update Date	:	12/07/2022

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Directions to “DALLAS COUNTY HOSPITAL DISTRICT ” Practice Location

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