Provider Demographics
NPI:1134125735
Name:QUALITY INFUSION CARE
Entity Type:Organization
Organization Name:QUALITY INFUSION CARE
Other - Org Name:QUALITY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-692-6666
Mailing Address - Street 1:5931 DESCO DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-1604
Mailing Address - Country:US
Mailing Address - Phone:214-692-6666
Mailing Address - Fax:214-692-6670
Practice Address - Street 1:6671 SOUTHWEST FREEWAY
Practice Address - Street 2:SUITE 777
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:214-692-6666
Practice Address - Fax:214-692-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006488251F00000X
TX45D0932241291U00000X
TX16579333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No291U00000XLaboratoriesClinical Medical Laboratory
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094683202Medicaid
TX094683201Medicaid
TX013245801Medicaid
TXCL5124Medicare ID - Type UnspecifiedLAB
TX013245801Medicaid