MEDICARE: CITY OF DALLAS EHS

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	251K00000X	Public Health or Welfare Agency
2	207Q00000X	Family Medicine 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	:	1992835573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF DALLAS EHS

Provider Business Mailing Address
First Line	:	1500 MARILLA DR
Second Line	:	7 AN
City	:	DALLAS
State	:	TX
Zip	:	75201-6318
Country	:	US
Telephone Number	:	214-670-0559
Fax Number	:	214-670-8991

Provider Business Practice Location Address
First Line	:	4500 SPRING AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75210-1350
Country	:	US
Telephone Number	:	214-670-0559
Fax Number	:	214-670-8991

Authorized Official
Title or Position	:	ELIGIBILITY CLERK
Name	:	MRS. GLORIA SALDIVAR
Credential	:
Telephone Number	:	214-670-0559

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/03/2008

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Directions to “CITY OF DALLAS EHS ” Practice Location

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