Provider Demographics
NPI:1760400642
Name:POWERS, DOBBS, & MENZINA, INC.
Entity Type:Organization
Organization Name:POWERS, DOBBS, & MENZINA, INC.
Other - Org Name:ARISTACARE HEALTH INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-490-3995
Mailing Address - Street 1:913 W LOOP 281
Mailing Address - Street 2:STE #105
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2901
Mailing Address - Country:US
Mailing Address - Phone:903-295-3338
Mailing Address - Fax:903-295-0004
Practice Address - Street 1:913 W LOOP 281
Practice Address - Street 2:STE #105
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2901
Practice Address - Country:US
Practice Address - Phone:903-295-3338
Practice Address - Fax:903-295-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15930251F00000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014554201Medicaid
TX750415OtherBC/BS
TX750415OtherBC/BS