Healthcare Provider Details

I. General information

NPI: 1871219683
Provider Name (Legal Business Name): SOUTH DALLAS INFUSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E BELT LINE RD STE 110
CEDAR HILL TX
75104-2423
US

IV. Provider business mailing address

950 E BELT LINE RD STE 110
CEDAR HILL TX
75104-2423
US

V. Phone/Fax

Practice location:
  • Phone: 945-212-3707
  • Fax: 945-212-3708
Mailing address:
  • Phone: 945-212-3707
  • Fax: 945-212-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KRISTI A. KUBOSH-SCHWARTZ
Title or Position: OWNER/PIC
Credential:
Phone: 945-212-3707