Provider Demographics
NPI:1770589392
Name:CHEST DIAGNOSTIC THERAPEUTIC SVCS & TRANSIT NURSING OF TX, INC
Entity type:Organization
Organization Name:CHEST DIAGNOSTIC THERAPEUTIC SVCS & TRANSIT NURSING OF TX, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:WRAGGE
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:254-562-3803
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-0289
Mailing Address - Country:US
Mailing Address - Phone:254-562-3803
Mailing Address - Fax:254-562-2372
Practice Address - Street 1:401 E MILAM ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-2329
Practice Address - Country:US
Practice Address - Phone:254-562-3803
Practice Address - Fax:254-562-2372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0010805332B00000X
TXATP 915332BC3200X
TX1000005332BX2000X
TX1000552332BX2000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX508325OtherBCBS PROVIDER NUMBER
TX086787110Medicaid
TX086787101Medicaid
TX508325OtherBCBS PROVIDER NUMBER
TX508325OtherBCBS PROVIDER NUMBER