Organization
MRT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON STEEN (OFFICE MANAGER)
(972) 417-6959
Entity
Organization
Contact information
Practice address
12035 SHILOH RD, DALLAS, TX 75228-1597
(972) 417-6959
(972) 417-6990
Mailing address
12035 SHILOH RD, DALLAS, TX 75228-1597
(972) 417-6959
(972) 417-6990
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4773690001
—
TX
Enumeration date
06/19/2006
Last updated
08/22/2020
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