Provider Demographics
NPI:1861690364
Name:DALLAS MEDICAL CENTER LLC
Entity type:Organization
Organization Name:DALLAS MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:METTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-320-7168
Mailing Address - Street 1:7 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7823
Mailing Address - Country:US
Mailing Address - Phone:972-247-1000
Mailing Address - Fax:972-888-7090
Practice Address - Street 1:7 MEDICAL PARKWAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7823
Practice Address - Country:US
Practice Address - Phone:972-247-1000
Practice Address - Fax:972-888-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X, 282N00000X
TX8564282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
#9007OtherJCAHO THE JOINT COMMISSION
TX1908253-02Medicaid
TX450379Medicare Oscar/Certification