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General NPI Number Information
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NPI Number | 1861297814
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Entity Type | Organization
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Legal Business Name | NEXUS MEDICAL SOURCE, INC.
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 202 W MAIN ST STE 101
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City | GUNTER
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State | TX
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Zip | 75058-2178
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Country | US
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Telephone | 682-557-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 4176 TOCCATA UNIT 108
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-0268
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Country | US
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Telephone | 682-557-2244
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLENN WRIGHT
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Credential |
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Telephone | 682-557-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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