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PED453302-38 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 Mockingbird 1; Center for Autism and Developmental Disabilities / Autism/Intensive Outpatient Autism
Type
Children's Hospital
Rural
No
340B ID
PED453302-38
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
7/29/2015
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
1341 West Mockingbird Lane, Suite 240W
Dallas, TX 75247-4966
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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7/29/15 Center for Autism and Developmental Disabilities is a joint program between Children's Medical Center of Dallas and UT Southwestern Medical Center
07/29/2015
June 2025
June 2025
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