Organization
DALLAS COUNTY HOSPITAL DISTRICT
Active
Other names
Vickery Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK P. CERISE M.D. (PRESIDENT & CHIEF EXECUTIVE OFFICER)
(214) 590-8006
Entity
Organization
Contact information
Practice address
8224 PARK LN STE 130, DALLAS, TX 75231-6021
(214) 266-0350
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
(214) 590-4105
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112177402
—
TX
05
—
112177403
—
TX
05
—
112177404
—
TX
Enumeration date
06/30/2006
Last updated
12/07/2022
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