Organization
DALLAS COUNTY HOSPITAL DISTRICT
Active
Other names
Southeast Dallas Acute Response Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK P CERISE MD (PRESIDENT & CHIEF EXECUTIVE OFFICER)
(214) 590-8006
Entity
Organization
Contact information
Practice address
9202 ELAM RD FL 1, DALLAS, TX 75217-4151
(214) 266-1834
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
355956901
—
TX
Enumeration date
02/17/2016
Last updated
12/07/2022
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