Healthcare Provider Details

I. General information

NPI: 1639439516
Provider Name (Legal Business Name): IVRX OUTPATIENT THERAPY SERVICES ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 GESSNER ROAD SUITE 525
HOUSTON TX
77024
US

IV. Provider business mailing address

915 GESSNER ROAD SUITE 525
HOUSTON TX
77024
US

V. Phone/Fax

Practice location:
  • Phone: 713-722-2253
  • Fax: 713-973-0805
Mailing address:
  • Phone: 713-722-2253
  • Fax: 713-973-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number690004
License Number StateTX

VIII. Authorized Official

Name: MIRANDA SUSANN CULLINS
Title or Position: REGISTERED NURSE
Credential: REGISTERED NURSE
Phone: 713-722-2253