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NPI Code Detail

MEDICARE: CORAM HEALTHCARE CORPORATION OF NORTH TEXAS

MEDICARE: CORAM HEALTHCARE CORPORATION OF NORTH TEXAS
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
1261QI0500XInfusion Therapy Clinic/Center

General Provider Information

NPI Number : 1902208879
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORAM HEALTHCARE CORPORATION OF NORTH TEXAS
Provider Business Mailing Address
First Line : 555 17TH ST
Second Line : SUITE 1500
City : DENVER
State : CO
Zip : 80202-3950
Country : US
Telephone Number : 303-672-8631
Fax Number :
Provider Business Practice Location Address
First Line : 6000 BRYANT IRVIN RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4116
Country : US
Telephone Number : 214-902-3600
Fax Number :
Authorized Official
Title or Position : SR VP, GC, SEC AND DIRECTOR
Name : MICHAEL E DELL
Credential :
Telephone Number : 303-672-8631
Provider Enumeration Date : 09/22/2014
Last Update Date : 09/22/2014

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