1134125735 NPI number — QUALITY INFUSION CARE

Table of content: (NPI 1134125735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134125735 NPI number — QUALITY INFUSION CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY INFUSION CARE
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:
QUALITY MEDICAL SERVICES
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:
1134125735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5931 DESCO DR
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:
75225-1604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-692-6666
Provider Business Mailing Address Fax Number:
214-692-6670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6671 SOUTHWEST FREEWAY
Provider Second Line Business Practice Location Address:
SUITE 777
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-692-6666
Provider Business Practice Location Address Fax Number:
214-692-6670
Provider Enumeration Date:
06/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MANGUM
Authorized Official First Name:
NAT
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
214-692-6666

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  006488 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 45D0932241 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 16579 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 094683202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 094683201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013245801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".