OrganizationDallas County Hospital District(Pediatric Primary Care Center)PediatricsAllopathic & Osteopathic PhysiciansPractice Address5151 Maple Ave # 6b, Dallas, TX 75235-8136(214) 266-0110PECOS EnrollmentBased on the most recent information from CMS, provider Dallas County Hospital District does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:37 AM.Profile DetailsProvider ID1093754475Provider TypeOrganizationFull NameDallas County Hospital DistrictOther NamePediatric Primary Care CenterSubpartNoEnumeration Date6/4/2006Last Updated7/10/2023Contact InformationPractice LocationPractice Address5151 Maple Ave # 6b, Dallas, TX 75235-8136Phone(214) 266-0110Fax(214) 266-0113Mailing LocationMailing AddressPO Box 660599, Dallas, TX 75266-0599PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameCerise, Fredrick P. (President & Chief Executive Officer)Phone(214) 590-8006Provider TaxonomiesCodeDescriptionLicenseCode208000000XPrimaryDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode363LP0200XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID111924001DescriptionMedicaidIssuerUnlistedTexasID111924002DescriptionMedicaidIssuerUnlistedTexasID133247005DescriptionMedicaidIssuerUnlistedTexas