Healthcare Provider Details

I. General information

NPI: 1629383336
Provider Name (Legal Business Name): MSN TEXAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MEDI PARK DR STE 39
AMARILLO TX
79106-2105
US

IV. Provider business mailing address

901 YAMATO RD STE 110
BOCA RATON FL
33431-4415
US

V. Phone/Fax

Practice location:
  • Phone: 806-353-2101
  • Fax: 806-353-2674
Mailing address:
  • Phone: 561-322-1300
  • Fax: 561-322-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number013735
License Number StateTX

VIII. Authorized Official

Name: MR. KEVIN LITTLE
Title or Position: PRESIDENT
Credential:
Phone: 561-322-1300