Provider Demographics
NPI:1750648788
Name:INTREPID USA INC.
Entity Type:Organization
Organization Name:INTREPID USA INC.
Other - Org Name:INTREPID USA HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-445-3750
Mailing Address - Street 1:4055 VALLEY VIEW LANE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244
Mailing Address - Country:US
Mailing Address - Phone:214-445-3750
Mailing Address - Fax:
Practice Address - Street 1:8365 UNIVERSITY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-1124
Practice Address - Country:US
Practice Address - Phone:515-223-9482
Practice Address - Fax:512-223-3571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
161603Medicare Oscar/Certification