MEDICARE: TRITRAX HEALTHCARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	009004	TX

General Provider Information

NPI Number	:	1144225707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRITRAX HEALTHCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	2261 BROOKHOLLOW PLAZA DR
Second Line	:	STE 106
City	:	ARLINGTON
State	:	TX
Zip	:	76006-7417
Country	:	US
Telephone Number	:	817-469-8340
Fax Number	:	817-469-8341

Provider Business Practice Location Address
First Line	:	2261 BROOKHOLLOW PLAZA DR
Second Line	:	STE 106
City	:	ARLINGTON
State	:	TX
Zip	:	76006-7417
Country	:	US
Telephone Number	:	817-469-8340
Fax Number	:	817-469-8341

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID SCOTT MITCHELL
Credential	:
Telephone Number	:	817-469-8340

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	11/28/2007

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