Provider Demographics
NPI:1467861179
Name:DUSARA CORPORATION
Entity type:Organization
Organization Name:DUSARA CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:B
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-206-5600
Mailing Address - Street 1:1329 W WALNUT HILL LN STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3027
Mailing Address - Country:US
Mailing Address - Phone:972-228-1820
Mailing Address - Fax:972-572-1112
Practice Address - Street 1:271 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1720
Practice Address - Country:US
Practice Address - Phone:205-206-5600
Practice Address - Fax:205-206-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1082332B00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4363290003Medicare NSC