Healthcare Provider Details

I. General information

NPI: 1598861296
Provider Name (Legal Business Name): BRILLSTONE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5481 BLAIR RD
DALLAS TX
75231-4101
US

IV. Provider business mailing address

5481 BLAIR RD
DALLAS TX
75231-4101
US

V. Phone/Fax

Practice location:
  • Phone: 214-369-7400
  • Fax: 214-369-7408
Mailing address:
  • Phone: 214-369-7400
  • Fax: 214-369-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0628
License Number StateTX

VIII. Authorized Official

Name: DR. LEON R BRILL
Title or Position: PHYSICIAN/PRESIDENT
Credential: DPM
Phone: 214-369-7400