Provider Demographics
NPI:1942862438
Name:MD STREAM, LLC
Entity Type:Organization
Organization Name:MD STREAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-749-8324
Mailing Address - Street 1:14850 QUORUM DR STE 440
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7001
Mailing Address - Country:US
Mailing Address - Phone:833-749-8324
Mailing Address - Fax:469-519-1400
Practice Address - Street 1:2129 FM 2920 RD # 190-279
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3671
Practice Address - Country:US
Practice Address - Phone:281-669-6310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty