Healthcare Provider Details

I. General information

NPI: 1023529690
Provider Name (Legal Business Name): AMERICAN GENERAL MERCHANTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 INTERSTATE 30 STE 108
MESQUITE TX
75150-2603
US

IV. Provider business mailing address

3213 INTERSTATE 30 STE 108
MESQUITE TX
75150-2603
US

V. Phone/Fax

Practice location:
  • Phone: 972-270-0500
  • Fax: 972-674-2944
Mailing address:
  • Phone: 972-270-0500
  • Fax: 972-674-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. IDRIS ELIJA SALIA
Title or Position: PRESIDENT
Credential:
Phone: 214-415-5554