Provider Demographics
NPI:1720398605
Name:FLAWLESS MEDICAL RESOURCES LLC
Entity Type:Organization
Organization Name:FLAWLESS MEDICAL RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-296-5255
Mailing Address - Street 1:1441 WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134-2980
Mailing Address - Country:US
Mailing Address - Phone:972-275-1645
Mailing Address - Fax:
Practice Address - Street 1:1441 WARWICK DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-2980
Practice Address - Country:US
Practice Address - Phone:972-275-1645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies