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General NPI Number Information
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NPI Number | 1376629329
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Entity Type | Organization
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Legal Business Name | ENTERRA MEDICAL DIAGNOSTICS LLC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 5787 S HAMPTON RD STE 255
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City | DALLAS
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State | TX
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Zip | 75232-2255
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Country | US
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Telephone | 214-330-7030
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Fax | 214-330-7073
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Provider Business Mailing Address
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Address Line | 5787 S HAMPTON RD STE 450
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City | DALLAS
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State | TX
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Zip | 75232-2255
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Country | US
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Telephone | 214-467-7434
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Fax | 214-467-7434
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Authorized Official
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Title or Position | OWNER
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Name | MR. PAUL KALUARACHI
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Credential |
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Telephone | 214-467-7434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0076258
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License Number State | TX
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