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PED453302-30 CHILDREN'S MEDICAL CENTER DALLAS (Active)
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Main Details
Name
CHILDREN'S MEDICAL CENTER DALLAS
Subdivision Name
Children's Health Specialty Center / Rheumatology
Type
Children's Hospital
Rural
No
340B ID
PED453302-30
Medicare Provider Number
453302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/6/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/22/2015
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
2350 North Stemmons Freeway
F6400
Dallas, TX 75207
Billing Address
Children's Medical Center of Dallas
1935 Medical District Drive
Dallas, TX 75235
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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