=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275678419
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIRECT CASE MANAGEMENT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8224 PARK LN SUITE 114
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-6011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-363-6579
-----------------------------------------------------
Fax | 214-363-3981
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8224 PARK LN SUITE 114
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-6011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-363-6579
-----------------------------------------------------
Fax | 214-363-3981
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. KENNETH FREDERICK -O
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 214-363-6579
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0071637
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------