Healthcare Provider Details

I. General information

NPI: 1376824508
Provider Name (Legal Business Name): ROSS ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3653 BRIARGROVE LN APT 1514
DALLAS TX
75287-6168
US

IV. Provider business mailing address

3653 BRIARGROVE LN APT 1514
DALLAS TX
75287-6168
US

V. Phone/Fax

Practice location:
  • Phone: 800-578-0347
  • Fax: 866-502-2998
Mailing address:
  • Phone: 502-594-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL ROSS
Title or Position: DIRECTOR
Credential:
Phone: 502-594-0020