MEDICARE: D. CUNNINGHAM ENTERPRISES

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1902009798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D. CUNNINGHAM ENTERPRISES

Provider Business Mailing Address
First Line	:	114 CEDAR VALLEY LN
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-1324
Country	:	US
Telephone Number	:	917-938-9587
Fax Number	:	817-987-2632

Provider Business Practice Location Address
First Line	:	903 GLYNN OAKS DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-5819
Country	:	US
Telephone Number	:	817-938-9587
Fax Number	:	817-987-2632

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DENESE CUNNINGHAM
Credential	:
Telephone Number	:	817-938-9587

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	08/22/2020

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