Ethereal Empire LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

ETHEREAL EMPIRE LLC

Practice address

1501 Perdido Dr
Euless, TX 76039-1415

Phone

(817) 785-9479

NPI assigned

Jan 25, 2024

Organization subpart

No

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

Authorized official

Name

Khatira Ali

Title

Ceo

Phone

(817) 785-9479

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1706140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706140800000",
    "number": "1659133734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 PERDIDO DR",
            "city": "EULESS",
            "state": "TX",
            "postal_code": "760391415",
            "telephone_number": "817-785-9479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 PERDIDO DR",
            "city": "EULESS",
            "state": "TX",
            "postal_code": "760391415",
            "telephone_number": "817-785-9479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHEREAL EMPIRE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-25",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "KHATIRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-785-9479"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Euless, TX
• Providers in Euless, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; 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.