Provider Demographics
NPI:1104102888
Name:UT SOUTHWESTERN MEDICAL CENTER
Entity type:Organization
Organization Name:UT SOUTHWESTERN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO CHAIR DEPT. NEUROSURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-648-7894
Mailing Address - Street 1:5161 HARRY HINES BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-8855
Mailing Address - Country:US
Mailing Address - Phone:214-648-7580
Mailing Address - Fax:214-648-2204
Practice Address - Street 1:5161 HARRY HINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-8855
Practice Address - Country:US
Practice Address - Phone:214-648-7580
Practice Address - Fax:214-648-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589350282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital