Healthcare Provider Details

I. General information

NPI: 1003081118
Provider Name (Legal Business Name): LINGRAY ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HEMPHILL ST
FORT WORTH TX
76104-3170
US

IV. Provider business mailing address

900 HEMPHILL ST
FORT WORTH TX
76104-3170
US

V. Phone/Fax

Practice location:
  • Phone: 817-870-9194
  • Fax: 817-870-1473
Mailing address:
  • Phone: 817-870-9194
  • Fax: 817-870-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: LINDA GAYE HENTZ
Title or Position: PRESIDENT
Credential:
Phone: 817-870-9194