Provider Demographics
NPI:1528583994
Name:BRICK BETTY
Entity Type:Organization
Organization Name:BRICK BETTY
Other - Org Name:VIOLET BY BRICK BETTY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:NEIGHBORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-534-8724
Mailing Address - Street 1:3839 MCKINNEY AVE STE 155-764
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3637 TIMBERGLEN RD APT 4102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-3590
Practice Address - Country:US
Practice Address - Phone:214-534-8724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies