Provider Demographics
NPI:1407954720
Name:CRITICAL PROVISIONS, INC
Entity Type:Organization
Organization Name:CRITICAL PROVISIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-739-9090
Mailing Address - Street 1:PO BOX 798
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75461-0798
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1705 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4650
Practice Address - Country:US
Practice Address - Phone:903-739-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005064251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459089Medicare ID - Type UnspecifiedPROVIDER NUMBER