=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467608893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARAGON INFUSION CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2008
-----------------------------------------------------
Last Update Date | 11/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3033 W PRESIDENT GEORGE BUSH HWY STE 100A
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-5884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-588-1000
-----------------------------------------------------
Fax | 972-588-1001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3033 W PRESIDENT GEORGE BUSH HWY STE 100
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-5885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-588-1000
-----------------------------------------------------
Fax | 972-588-1000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | AMY MULDERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-588-1050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 22975
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------