Provider Demographics
NPI:1750334629
Name:CANAAN MEDICAL SERVICES
Entity type:Organization
Organization Name:CANAAN MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-PIERRE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOBOUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-258-0800
Mailing Address - Street 1:2121 W AIRPORT FWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6008
Mailing Address - Country:US
Mailing Address - Phone:972-258-0800
Mailing Address - Fax:972-258-0977
Practice Address - Street 1:2121 W AIRPORT FWY
Practice Address - Street 2:SUITE 230
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6008
Practice Address - Country:US
Practice Address - Phone:972-258-0800
Practice Address - Fax:972-258-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0088798332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176523201Medicaid
TX5517430001Medicare ID - Type Unspecified