Provider Demographics
NPI:1073712329
Name:HEALTHCARE ASSOCIATES OF IRVING
Entity Type:Organization
Organization Name:HEALTHCARE ASSOCIATES OF IRVING
Other - Org Name:BOARDWALK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEEMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-258-7499
Mailing Address - Street 1:6161 N STATE HIGHWAY 161
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2220
Mailing Address - Country:US
Mailing Address - Phone:972-812-7559
Mailing Address - Fax:
Practice Address - Street 1:6161 N STATE HIGHWAY 161
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2220
Practice Address - Country:US
Practice Address - Phone:972-812-7559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHCARE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-17
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4545298OtherNCPDP