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PED453302-00 CHILDREN'S MEDICAL CENTER DALLAS (Active)
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Main Details
Name
CHILDREN'S MEDICAL CENTER DALLAS
Subdivision Name
Type
Children's Hospital
Rural
No
340B ID
PED453302-00
Medicare Provider Number
453302
Additional Details
Current Program Status
Active
Registration Date
3/25/2010
Participating Start Date
4/1/2010
Participating Approval Date
3/25/2010
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Children's Health
Robert S. Fries, Chief Financial Officer
(214) 456-8414
Primary Contact
Children's Health
Chris Bradley Geiger, Director Business Operations, Ancillary Services
(214) 456-7437
Addresses
Street Address
1935 MEDICAL DISTRICT DRIVE
DALLAS, TX 75235
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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1/31/12 UPDATED SHIP ADD NAME (WAS PAVILLION SURGERY CENTER PHARMACY)
01/31/2012
May 2025
May 2025
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