Provider Demographics
NPI:1326599499
Name:TEXAS HEALTH MEDICAL SUPPORT
Entity Type:Organization
Organization Name:TEXAS HEALTH MEDICAL SUPPORT
Other - Org Name:TEXAS HEALTH SPECIALTY PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-236-2550
Mailing Address - Street 1:600 E. LAMAR BLVD.
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 BRIDGEWOOD DR STE 107
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-0808
Practice Address - Country:US
Practice Address - Phone:682-236-2550
Practice Address - Fax:682-236-0050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS HEALTH RESOURCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-24
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315603336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy