Provider Demographics
NPI:1346514494
Name:DJF ENTERPRISE, PLLC
Entity Type:Organization
Organization Name:DJF ENTERPRISE, PLLC
Other - Org Name:BRAZOS HOMECARE MEDICAL SERVICES / BRAZOS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FEDRO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:254-300-4399
Mailing Address - Street 1:688 ALLIANCE PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3585
Mailing Address - Country:US
Mailing Address - Phone:254-300-4399
Mailing Address - Fax:254-300-4401
Practice Address - Street 1:688 ALLIANCE PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643-3585
Practice Address - Country:US
Practice Address - Phone:254-300-4399
Practice Address - Fax:254-300-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3347261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD97329Medicare UPIN