1831122829 NPI number — CRESCENT DME SERVICES, INC

Table of content: (NPI 1831122829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831122829 NPI number — CRESCENT DME SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRESCENT DME SERVICES, 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:
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:
1831122829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 182411
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76096-2411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-801-1212
Provider Business Mailing Address Fax Number:
817-801-0005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2238 MICHIGAN AVE
Provider Second Line Business Practice Location Address:
G
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76013-5945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
807-801-1212
Provider Business Practice Location Address Fax Number:
817-801-0005
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAIKH
Authorized Official First Name:
MOHAMMED
Authorized Official Middle Name:
I
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-801-1212

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  0039845 , 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)

  • Identifier: 149132601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 531546 . This is a "BC/BS PROVIDER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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