Provider Demographics
NPI:1265645196
Name:STEADFAST GROUP, LLC
Entity Type:Organization
Organization Name:STEADFAST GROUP, LLC
Other - Org Name:GENESIS MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BIBIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-278-9840
Mailing Address - Street 1:1008 STONEWALL ST STE A
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1565
Mailing Address - Country:US
Mailing Address - Phone:972-278-9840
Mailing Address - Fax:
Practice Address - Street 1:1008 STONEWALL ST STE A
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1565
Practice Address - Country:US
Practice Address - Phone:972-278-9840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0095276305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service