Healthcare Provider Details

I. General information

NPI: 1285678490
Provider Name (Legal Business Name): CENTRAL LINE INFUSION DALLAS DIVISION LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 TRISTAR DRIVE SUITE 120
IRVING TX
75063-2823
US

IV. Provider business mailing address

PO BOX 223017
PITTSBURGH PA
15251-2017
US

V. Phone/Fax

Practice location:
  • Phone: 972-815-0460
  • Fax: 972-915-3841
Mailing address:
  • Phone: 800-477-7375
  • Fax: 877-676-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number23275
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number23275
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number23275
License Number StateTX

VIII. Authorized Official

Name: ALEX KATEN
Title or Position: CFO
Credential:
Phone: 800-477-7375