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PED453302-44 CHILDREN'S MEDICAL CENTER DALLAS (Terminated)
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Main Details
Name
CHILDREN'S MEDICAL CENTER DALLAS
Subdivision Name
Children's Health Specialty Center, South Rockwall - Urology Clinic
Type
Children's Hospital
Rural
No
340B ID
PED453302-44
Medicare Provider Number
453302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2019
Participating Start Date
10/1/2019
Participating Approval Date
8/16/2019
Last Recertification Date
9/2/2020
Termination Date
Termination Reason
10/1/2021
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Children’s Health
Jeremiah Radandt, President Corporate Services & CFO
(214) 456-2522
Primary Contact
Children's Health
Chris Bradley Geiger, Director Business Operations, Ancillary Services
(214) 456-7437
Addresses
Street Address
1005 West Ralph Hall Parkway
Rockwall, TX 75032
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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