Provider Demographics
NPI:1275573594
Name:CAPSTONE HEALTH GRP LLC
Entity Type:Organization
Organization Name:CAPSTONE HEALTH GRP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHOTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-773-2376
Mailing Address - Street 1:300 OLIVE ST STE 505
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854
Mailing Address - Country:US
Mailing Address - Phone:870-773-2376
Mailing Address - Fax:870-773-2517
Practice Address - Street 1:300 OLIVE ST STE 505
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854
Practice Address - Country:US
Practice Address - Phone:870-773-2376
Practice Address - Fax:870-773-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR332BP3500X332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4868330001Medicare ID - Type Unspecified