Provider Demographics
NPI:1639439516
Name:IVRX OUTPATIENT THERAPY SERVICES ENTERPRISES INC
Entity type:Organization
Organization Name:IVRX OUTPATIENT THERAPY SERVICES ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:SUSANN
Authorized Official - Last Name:CULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:713-722-2253
Mailing Address - Street 1:915 GESSNER ROAD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024
Mailing Address - Country:US
Mailing Address - Phone:713-722-2253
Mailing Address - Fax:713-973-0805
Practice Address - Street 1:915 GESSNER ROAD
Practice Address - Street 2:SUITE 525
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:713-722-2253
Practice Address - Fax:713-973-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX690004163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty