1598700874 NPI number — PLATINUM DME, LLC

Table of content: (NPI 1598700874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598700874 NPI number — PLATINUM DME, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLATINUM DME, LLC
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:
Provider Other Organization Name Type Code:
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:
1598700874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10449 E CLOVER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75126-7915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-564-6511
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9330 AMBERTON PKWY
Provider Second Line Business Practice Location Address:
STE. 1220
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-3278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-389-1907
Provider Business Practice Location Address Fax Number:
214-389-1908
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIMSON
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER/MEMBER
Authorized Official Telephone Number:
214-213-3952

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0086488 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com