Provider Demographics
NPI:1881919231
Name:PDS HEALTH, INC
Entity type:Organization
Organization Name:PDS HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LYSAGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-737-4584
Mailing Address - Street 1:112 INTRACOASTAL POINTE DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5063
Mailing Address - Country:US
Mailing Address - Phone:877-737-4584
Mailing Address - Fax:800-590-3441
Practice Address - Street 1:112 INTRACOASTAL POINTE DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5063
Practice Address - Country:US
Practice Address - Phone:877-737-4584
Practice Address - Fax:800-590-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2009-09734332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies