MEDICARE: PROMETHEUS SERVICES

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	3336C0003X	Community/Retail Pharmacy	26327	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4551253	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1275771057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMETHEUS SERVICES

Provider Business Mailing Address
First Line	:	2636 WALNUT HILL LN
Second Line	:	SUITE 335
City	:	DALLAS
State	:	TX
Zip	:	75229-5639
Country	:	US
Telephone Number	:	214-357-3779
Fax Number	:

Provider Business Practice Location Address
First Line	:	2636 WALNUT HILL LN
Second Line	:	SUITE 335
City	:	DALLAS
State	:	TX
Zip	:	75229-5639
Country	:	US
Telephone Number	:	214-357-3779
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY WILLIAMS
Credential	:
Telephone Number	:	817-262-2421

Provider Enumeration Date	:	02/02/2009
Last Update Date	:	06/23/2009

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Directions to “PROMETHEUS SERVICES ” Practice Location

Language	Start Address	Practice Location

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