Provider Demographics
NPI:1467608893
Name:PARAGON INFUSION CARE, INC
Entity Type:Organization
Organization Name:PARAGON INFUSION CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-588-1050
Mailing Address - Street 1:17111 PRESTON RD
Mailing Address - Street 2:STE 160B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1229
Mailing Address - Country:US
Mailing Address - Phone:972-588-1000
Mailing Address - Fax:972-588-1041
Practice Address - Street 1:17111 PRESTON RD
Practice Address - Street 2:STE 160B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1229
Practice Address - Country:US
Practice Address - Phone:972-588-1000
Practice Address - Fax:972-588-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22975332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531303OtherBCBS TX