Organization Active NPI

Prudential Medical Network, LP

  • Durable Medical Equipment & Medical Supplies
  • Midlothian, TX
National Provider Identifier
1003025784
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PRUDENTIAL MEDICAL NETWORK, LP
Practice address
5455 Honeysuckle Rd
Midlothian, TX 76065-7006
Phone
(972) 567-9571
Fax
(817) 563-6934
NPI assigned
May 21, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kelly Dean Sanders, OPA-CNPI 1619296274
Title
Co President
Phone
(817) 714-9066

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

5455 Honeysuckle Rd
Midlothian, TX 76065-7006

Mailing address

5455 Honeysuckle Rd
Midlothian, TX 76065-7006
Phone (972) 567-9571

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003025784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5455 HONEYSUCKLE RD",
            "city": "MIDLOTHIAN",
            "state": "TX",
            "postal_code": "760657006",
            "telephone_number": "972-567-9571",
            "fax_number": "817-563-6934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5455 HONEYSUCKLE RD",
            "city": "MIDLOTHIAN",
            "state": "TX",
            "postal_code": "760657006",
            "telephone_number": "972-567-9571",
            "fax_number": "817-563-6934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUDENTIAL MEDICAL NETWORK, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "CO PRESIDENT",
        "authorized_official_telephone_number": "817-714-9066",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OPA-C"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midlothian, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.