Provider Demographics
NPI:1649042417
Name:MEDHEALTH
Entity type:Organization
Organization Name:MEDHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KENYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-947-4523
Mailing Address - Street 1:4560 LAKE RIDGE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-1706
Mailing Address - Country:US
Mailing Address - Phone:817-453-3500
Mailing Address - Fax:817-453-3520
Practice Address - Street 1:4560 LAKE RIDGE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-1706
Practice Address - Country:US
Practice Address - Phone:817-453-3500
Practice Address - Fax:817-453-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies