Healthcare Provider Details

I. General information

NPI: 1558748152
Provider Name (Legal Business Name): CDS ACCOUNT MANAGERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 BAYSIDE DR
WYLIE TX
75098-7806
US

IV. Provider business mailing address

1206 BAYSIDE DR
WYLIE TX
75098-7806
US

V. Phone/Fax

Practice location:
  • Phone: 214-724-1499
  • Fax:
Mailing address:
  • Phone: 214-724-1499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. FORTUNE EZEOHA
Title or Position: ADMINISTRATOR
Credential:
Phone: 214-724-1499