Provider Demographics
NPI:1265102925
Name:CLINICAL SPECIALTY INFUSIONS OF DALLAS LLC
Entity type:Organization
Organization Name:CLINICAL SPECIALTY INFUSIONS OF DALLAS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHEETS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:833-569-1005
Mailing Address - Street 1:459 E NEW BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:NASH
Mailing Address - State:TX
Mailing Address - Zip Code:75569-2715
Mailing Address - Country:US
Mailing Address - Phone:833-569-1005
Mailing Address - Fax:430-200-4889
Practice Address - Street 1:459 E NEW BOSTON RD
Practice Address - Street 2:
Practice Address - City:NASH
Practice Address - State:TX
Practice Address - Zip Code:75569-2715
Practice Address - Country:US
Practice Address - Phone:833-569-1005
Practice Address - Fax:430-200-4889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICAL SPECIALTY INFUSIONS OF DALLAS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-15
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149579Medicaid
TX3951113Medicaid
AR220687407Medicaid