=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376542837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOOD NIGHT MEDICAL OF TEXAS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2005
-----------------------------------------------------
Last Update Date | 10/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6431 SOUTHWEST BLVD
-----------------------------------------------------
City | BENBROOK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76132-2777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-467-6555
-----------------------------------------------------
Fax | 614-386-0278
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1019 TOWN DR
-----------------------------------------------------
City | HIGHLAND HEIGHTS
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41076-9114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | GREGORY J CRAWFORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-441-8876
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | 0077472
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0077472
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------