MEDICARE: SENERGY MEDICAL GROUP

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)

General Provider Information

NPI Number	:	1982843371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENERGY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	5445 LA SIERRA DR
Second Line	:	SUITE 410
City	:	DALLAS
State	:	TX
Zip	:	75231-4139
Country	:	US
Telephone Number	:	214-382-1909
Fax Number	:

Provider Business Practice Location Address
First Line	:	9901 VALLEY RANCH PKWY E
Second Line	:	SUITE 200
City	:	IRVING
State	:	TX
Zip	:	75063-4730
Country	:	US
Telephone Number	:	972-580-0545
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	KARLA BASS
Credential	:
Telephone Number	:	214-616-7566

Provider Enumeration Date	:	02/09/2009
Last Update Date	:	02/09/2009

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