Provider Demographics
NPI:1437588142
Name:MEDI-DIRECT HEALTHCARE SOLUTIONS LLC
Entity Type:Organization
Organization Name:MEDI-DIRECT HEALTHCARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MAHALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:214-277-2243
Mailing Address - Street 1:9540 GARLAND RD STE 381-422
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-5004
Mailing Address - Country:US
Mailing Address - Phone:214-865-6389
Mailing Address - Fax:214-865-6389
Practice Address - Street 1:9540 GARLAND RD
Practice Address - Street 2:STE. 381-422
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-5004
Practice Address - Country:US
Practice Address - Phone:214-277-2243
Practice Address - Fax:214-231-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-03
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 261QH0100X, 305R00000X, 261QH0100X
TX715590363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251J00000XAgenciesNursing Care
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider Organization