MEDICARE: CHEST DIAGNOSTIC THERAPEUTIC SVCS & TRANSIT NURSING OF TX, INC

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	332BC3200X	Customized Equipment (DME)	ATP 915	TX
2	332BX2000X	Oxygen Equipment & Supplies (DME)	0063038	TX
3	332B00000X	Durable Medical Equipment & Medical Supplies	0011681	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	519093	OTHER	TX	BCBS PROVIDER NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609873256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHEST DIAGNOSTIC THERAPEUTIC SVCS & TRANSIT NURSING OF TX, INC

Provider Business Mailing Address
First Line	:	PO BOX 289
Second Line	:
City	:	MEXIA
State	:	TX
Zip	:	76667-0289
Country	:	US
Telephone Number	:	254-562-3803
Fax Number	:	254-562-2372

Provider Business Practice Location Address
First Line	:	3205A W 2ND AVE
Second Line	:
City	:	CORSICANA
State	:	TX
Zip	:	75110-2409
Country	:	US
Telephone Number	:	903-872-3611
Fax Number	:	903-872-3465

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. WILLIAM H WRAGGE
Credential	:	RRT
Telephone Number	:	254-562-3803

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	03/01/2012

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