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General NPI Number Information
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NPI Number | 1104227214
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Entity Type | Organization
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Legal Business Name | QUUXX
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Dates
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Enumeration Date | 09/08/2014
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 6651 BLACKJACK OAKS RD
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City | AUBREY
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State | TX
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Zip | 76227-3609
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Country | US
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Telephone | 214-794-8006
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Fax |
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Provider Business Mailing Address
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Address Line | 6651 BLACKJACK OAKS RD
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City | AUBREY
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State | TX
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Zip | 76227-3609
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Country | US
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Telephone | 214-794-8006
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK VANDER MEIDEN
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Credential |
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Telephone | 214-728-5067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State |
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