Healthcare Provider Details

I. General information

NPI: 1134125735
Provider Name (Legal Business Name): QUALITY INFUSION CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6671 SOUTHWEST FREEWAY SUITE 777
HOUSTON TX
77074
US

IV. Provider business mailing address

5931 DESCO DR
DALLAS TX
75225-1604
US

V. Phone/Fax

Practice location:
  • Phone: 214-692-6666
  • Fax: 214-692-6670
Mailing address:
  • Phone: 214-692-6666
  • Fax: 214-692-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number45D0932241
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number16579
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number006488
License Number StateTX

VIII. Authorized Official

Name: NAT E. MANGUM
Title or Position: CEO
Credential:
Phone: 214-692-6666