Provider Demographics
NPI:1295791028
Name:BO DAVID BROWN
Entity type:Organization
Organization Name:BO DAVID BROWN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-434-1700
Mailing Address - Street 1:PO BOX 293701
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75029-3701
Mailing Address - Country:US
Mailing Address - Phone:972-434-1700
Mailing Address - Fax:972-221-0099
Practice Address - Street 1:211 S. STEMMONS FREEWAY
Practice Address - Street 2:SUITE F
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4593
Practice Address - Country:US
Practice Address - Phone:972-434-1700
Practice Address - Fax:972-221-0099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOBILITY HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-21
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0067910332BX2000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144319401Medicaid
TX144321001Medicaid
TX4178240001Medicare ID - Type UnspecifiedMEDICARE NUMBER