Provider Demographics
NPI:1982680260
Name:MED-LINK OF NORTH TEXAS SYSTEMS, INC.
Entity Type:Organization
Organization Name:MED-LINK OF NORTH TEXAS SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PICKRELL
Authorized Official - Suffix:IX
Authorized Official - Credentials:NONE
Authorized Official - Phone:817-478-8077
Mailing Address - Street 1:501 W KENNEDALE PKWY
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-4619
Mailing Address - Country:US
Mailing Address - Phone:817-478-8077
Mailing Address - Fax:817-483-5009
Practice Address - Street 1:501 W KENNEDALE PKWY
Practice Address - Street 2:
Practice Address - City:KENNEDALE
Practice Address - State:TX
Practice Address - Zip Code:76060-4619
Practice Address - Country:US
Practice Address - Phone:817-478-8077
Practice Address - Fax:817-483-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0051649332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155990801Medicaid
TX5082640001Medicare NSC