MEDICARE: ENTERRA MEDICAL DIAGNOSTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0076258	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376629329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENTERRA MEDICAL DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	5787 S HAMPTON RD
Second Line	:	STE 450
City	:	DALLAS
State	:	TX
Zip	:	75232-2255
Country	:	US
Telephone Number	:	214-467-7434
Fax Number	:	214-467-7434

Provider Business Practice Location Address
First Line	:	5787 S HAMPTON RD
Second Line	:	STE 255
City	:	DALLAS
State	:	TX
Zip	:	75232-2255
Country	:	US
Telephone Number	:	214-330-7030
Fax Number	:	214-330-7073

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PAUL KALUARACHI
Credential	:
Telephone Number	:	214-467-7434

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	03/21/2011

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Directions to “ENTERRA MEDICAL DIAGNOSTICS LLC ” Practice Location

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