Healthcare Provider Details

I. General information

NPI: 1710982301
Provider Name (Legal Business Name): CARDIOPULMONARY THERAPEUTICS AND DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 IMPERIAL DR
WACO TX
76712-6605
US

IV. Provider business mailing address

PO BOX 8160
WACO TX
76714-8160
US

V. Phone/Fax

Practice location:
  • Phone: 254-772-6970
  • Fax: 866-725-4443
Mailing address:
  • Phone: 254-772-6970
  • Fax: 866-725-4443

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 Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES RECKS
Title or Position: PRESIDENT
Credential:
Phone: 254-772-6970