# CHILDRENS MEDICAL CENTER DALLAS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851458038
- **Authorized official:** MS. STEPHANIE DETAMORE ATHRE RN, MSN CPNP (NURSE PRACTITIONER)
- **Authorized official phone:** (214) 456-5614

## Contact information

- **Practice address:** 1935 MOTOR ST, DALLAS, TX 75235-7701
- **Practice address phone:** (214) 456-5614
- **Mailing address:** 5060 WATEKA DR, DALLAS, TX 75209-4825
- **Mailing address phone:** (214) 353-2775
- **Mailing address fax:** (214) 456-5071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282NC2000X | Children's Hospital | 630600 | TX | Yes |

## Other

- **Enumeration date:** 01/03/2007
- **Last updated:** 08/22/2020