Provider Demographics
NPI:1164458360
Name:IKE GINIS
Entity Type:Organization
Organization Name:IKE GINIS
Other - Org Name:PHELIYK MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GINIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-699-7600
Mailing Address - Street 1:777 S CENTRAL EXPY
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7411
Mailing Address - Country:US
Mailing Address - Phone:972-699-7600
Mailing Address - Fax:
Practice Address - Street 1:777 S CENTRAL EXPY
Practice Address - Street 2:SUITE 1B
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7411
Practice Address - Country:US
Practice Address - Phone:972-699-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0062948332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154401702Medicaid
TX154401701Medicaid
TX154401701Medicaid