Provider Demographics
NPI:1174507339
Name:LANDMARK HEALTHCARE INC
Entity Type:Organization
Organization Name:LANDMARK HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:N
Authorized Official - Last Name:MAJERUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-529-2121
Mailing Address - Street 1:3455 NE LOOP 820
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-2414
Mailing Address - Country:US
Mailing Address - Phone:817-338-0007
Mailing Address - Fax:817-338-0816
Practice Address - Street 1:300 BOONE RD STE A5
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-2900
Practice Address - Country:US
Practice Address - Phone:817-529-3600
Practice Address - Fax:817-338-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0042220332B00000X
TX004220332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1297170001Medicare NSC