Provider Demographics
NPI:1760663744
Name:VIJI ANTONY
Entity Type:Organization
Organization Name:VIJI ANTONY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-285-5700
Mailing Address - Street 1:740 MILITARY PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-4166
Mailing Address - Country:US
Mailing Address - Phone:972-285-5700
Mailing Address - Fax:972-289-7771
Practice Address - Street 1:740 MILITARY PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-4166
Practice Address - Country:US
Practice Address - Phone:972-285-5700
Practice Address - Fax:972-289-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531856OtherBLUE CROSS BLUE SHIELD
TX531856OtherBLUE CROSS BLUE SHIELD