Enterra Medical Diagnostics LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

0076258 Issued in TX

Legal business name

ENTERRA MEDICAL DIAGNOSTICS LLC

Practice address

5787 S Hampton Rd
Ste 255
Dallas, TX 75232-2255

Phone

(214) 330-7030

Fax

(214) 330-7073

NPI assigned

Oct 31, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Paul Kaluarachi

Title

Owner

Phone

(214) 467-7434

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1376629329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5787 S HAMPTON RD",
            "address_2": "STE 450",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752322255",
            "telephone_number": "214-467-7434",
            "fax_number": "214-467-7434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5787 S HAMPTON RD",
            "address_2": "STE 255",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752322255",
            "telephone_number": "214-330-7030",
            "fax_number": "214-330-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENTERRA MEDICAL DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "KALUARACHI",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-467-7434",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "0076258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179148501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179148502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; 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.