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General NPI Number Information
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NPI Number | 1023362084
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Entity Type | Organization
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Legal Business Name | CRYSTAL MAS INTERNATIONAL
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 4101 AIRPORT FWY SUITE 227
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City | BEDFORD
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State | TX
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Zip | 76021-6130
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Country | US
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Telephone | 817-868-1040
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Fax | 817-868-1042
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Provider Business Mailing Address
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Address Line | 4101 AIRPORT FWY SUITE 227
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City | BEDFORD
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State | TX
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Zip | 76021-6129
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Country | US
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Telephone | 817-868-1040
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Fax | 817-868-1042
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Authorized Official
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Title or Position | OWNER
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Name | MR. OLAMIDE ADEYEMI
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Credential |
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Telephone | 972-201-8568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1000833
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License Number State | TX
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