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General NPI Number Information
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NPI Number | 1932630100
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Entity Type | Organization
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Legal Business Name | IT3 MEDICAL LLC
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 7709 SAN JACINTO PL STE 101 BLDG 3
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City | PLANO
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State | TX
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Zip | 75024-3215
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Country | US
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Telephone | 469-453-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 190 E STACY RD STE 306-298
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City | ALLEN
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State | TX
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Zip | 75002-8734
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Country | US
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Telephone | 469-453-0300
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Fax |
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Authorized Official
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Title or Position | BILLING DIRECTOR
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Name | BELINDA ACOSTA
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Credential |
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Telephone | 469-453-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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