1750473252 NPI number — DEGC ENTERPRISES (U.S.), INC.

Table of content: (NPI 1750473252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750473252 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:
1750473252
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:
3601 THIRLANE RD NW STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24019-3080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-359-9641
Provider Business Practice Location Address Fax Number:
800-540-2259
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: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 554461-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003115482B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0071099160003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810017344 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008051702 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750473252 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750473252 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000697903E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018769500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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