Provider Demographics
NPI:1063100071
Name:ALIVEDRIPCENTERS
Entity type:Organization
Organization Name:ALIVEDRIPCENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-310-8206
Mailing Address - Street 1:P.O. BOX 119-154
Mailing Address - Street 2:2221 JUSTIN ROAD
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-4848
Mailing Address - Country:US
Mailing Address - Phone:214-310-8206
Mailing Address - Fax:
Practice Address - Street 1:507 LONGFELLOW LN
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TX
Practice Address - Zip Code:75069-0155
Practice Address - Country:US
Practice Address - Phone:214-310-8206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy