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Organization

CHOICE SOURCE THERAPEUTIC OF HOUSTON, TEXAS, L.L.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DAVID WILLIAM BORDER (AUTHORIZED SIGNER)
(800) 225-5967
Entity
Organization

Contact information

Practice address
20333 STATE HIGHWAY 249, SUITE 450, HOUSTON, TX 77070
(281) 257-7900
(281) 257-7920
Mailing address
PO BOX 840688, DALLAS, TX 75284-0688
(800) 225-5967
(909) 799-4364

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
19617
TX
333600000X
Pharmacy
19617
TX
3336H0001X
Home Infusion Therapy Pharmacy
19617
TX
3336S0011X
Specialty Pharmacy
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009914034
AL
05
091576104
TX
05
091576105
TX
05
100245870A
OK
05
100560035
AL
05
200422190
IN
05
2441423
OH
01
320199
CHIP
TX
05
320199
TX
01
580024
MEDICARE B (TRAILBLAZER)
TX
05
806568400
ID
01
AH05
HEMO ASSISTANCE
TX
Enumeration date
11/08/2005
Last updated
04/23/2010
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