Provider Demographics
NPI:1396288338
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:
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:430-200-4870
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311003336H0001X
NMPH000044573336H0001X
IL0540205233336H0001X
WYNR-513593336H0001X
251F00000X, 332B00000X, 3336S0011X
DEA9-0002021333600000X
AZY0072613336C0004X
IN64002405A3336H0001X
COOSP.00069793336S0011X
AROSO27903336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160928OtherPK
TX3951113Medicaid
TX149579Medicaid
AR220687407Medicaid