Provider Demographics
NPI:1508850793
Name:HDK ENTERPRISES LLC
Entity Type:Organization
Organization Name:HDK ENTERPRISES LLC
Other - Org Name:SOUTHSIDE INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-660-8888
Mailing Address - Street 1:7700 MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4456
Mailing Address - Country:US
Mailing Address - Phone:713-660-8888
Mailing Address - Fax:713-661-4828
Practice Address - Street 1:7700 MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4456
Practice Address - Country:US
Practice Address - Phone:713-660-8888
Practice Address - Fax:713-661-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14797261QI0500X, 3336C0003X
332B00000X, 3336C0004X, 3336H0001X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143781Medicaid
TX4584430OtherNCPDP
0828790001Medicare NSC