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NPI Code Detail

MEDICARE: DOMICILLIARY SERVICE LLC

MEDICARE: DOMICILLIARY SERVICE 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
1173000000XLegal MedicineTX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DO1083OTHERRAILROAD MEDICARE PTAN

General Provider Information

NPI Number : 1710172093
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOMICILLIARY SERVICE LLC
Provider Business Mailing Address
First Line : 1513 VICEROY DR
Second Line :
City : DALLAS
State : TX
Zip : 75235-2303
Country : US
Telephone Number : 469-685-7020
Fax Number : 214-920-8446
Provider Business Practice Location Address
First Line : 1513 VICEROY DR
Second Line :
City : DALLAS
State : TX
Zip : 75235-2303
Country : US
Telephone Number : 469-685-7020
Fax Number : 214-920-8446
Authorized Official
Title or Position : PRESIDENT
Name : DR. MANUEL S RIVERO
Credential : M.D.
Telephone Number : 469-595-9475
Provider Enumeration Date : 09/11/2007
Last Update Date : 07/21/2022

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Directions to “DOMICILLIARY SERVICE LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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