Healthcare Provider Details

I. General information

NPI: 1265102925
Provider Name (Legal Business Name): CLINICAL SPECIALTY INFUSIONS OF DALLAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 02/23/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 E NEW BOSTON RD
NASH TX
75569-2715
US

IV. Provider business mailing address

459 E NEW BOSTON RD
NASH TX
75569-2715
US

V. Phone/Fax

Practice location:
  • Phone: 833-569-1005
  • Fax: 430-200-4889
Mailing address:
  • Phone: 833-569-1005
  • Fax: 430-200-4889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES LYNN SHEETS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHARMD
Phone: 833-569-1005