1295827780 NPI number — DEGC ENTERPRISES (U.S.), INC.

Table of content: (NPI 1295827780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295827780 NPI number — DEGC ENTERPRISES (U.S.), INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEGC ENTERPRISES (U.S.), INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CCS MEDICAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295827780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3030 LBJ FWY STE 1525
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75234-7758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-628-2100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14255 49TH ST N STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33762-2813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-308-8882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOFMEISTER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
972-628-2100

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X , with the licence number: PH16544 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1295827780 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1452096 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200485810B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2410695 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 270170 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4661820 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00475041 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 095938 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1295827780 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 418557900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0071099160002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110120704A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21134880 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 418555200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4582026 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 554461-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000S2341 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003115482A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008051699 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 019655038 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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