Organization
SOUTHLAKE SPECIALTY HOSPITAL, LLC
Active
Other names
Texas Health Harris Methodist Hospital Southlake
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACI BERNARD (PRESIDENT)
(817) 748-8784
Entity
Organization
Contact information
Practice address
1545 SOUTHLAKE BLVD., SOUTHLAKE, TX 76092-6422
(817) 748-8784
(817) 748-8787
Mailing address
PO BOX 735801, DALLAS, TX 75373-5801
(972) 419-6704
(972) 419-8118
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
008128
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1714610-01
—
TX
01
—
HH1061
BCBS PROVIDER NUMBER
TX
Enumeration date
09/22/2005
Last updated
02/18/2025
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