Healthcare Provider Details

I. General information

NPI: 1770213464
Provider Name (Legal Business Name): BYRON BERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18211 KELLY BLVD APT 1313
DALLAS TX
75287-4639
US

IV. Provider business mailing address

18211 KELLY BLVD APT 1313
DALLAS TX
75287-4639
US

V. Phone/Fax

Practice location:
  • Phone: 205-370-4147
  • Fax:
Mailing address:
  • Phone: 205-370-4147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: