Provider Demographics
NPI:1083787865
Name:EAST TEXAS RAYON SERVICES, LLC
Entity Type:Organization
Organization Name:EAST TEXAS RAYON SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-569-9023
Mailing Address - Street 1:5361 S STATE HIGH WAY 37
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773
Mailing Address - Country:US
Mailing Address - Phone:903-569-9023
Mailing Address - Fax:903-569-9374
Practice Address - Street 1:5361 S STATE HIGH WAY 37
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773
Practice Address - Country:US
Practice Address - Phone:903-569-9023
Practice Address - Fax:903-569-9374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172681202Medicaid
TX172681201Medicaid
TX172681202Medicaid