Provider Demographics
NPI:1295084572
Name:AZURITE MEDICAL
Entity type:Organization
Organization Name:AZURITE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:
Authorized Official - Credentials:RMA NCT
Authorized Official - Phone:469-269-2424
Mailing Address - Street 1:3569 PORTLAND ST
Mailing Address - Street 2:SUITE 1033
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-2952
Mailing Address - Country:US
Mailing Address - Phone:469-269-2424
Mailing Address - Fax:972-638-8612
Practice Address - Street 1:3569 PORTLAND ST
Practice Address - Street 2:SUITE 1033
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2952
Practice Address - Country:US
Practice Address - Phone:469-269-2424
Practice Address - Fax:972-638-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health