Provider Demographics
NPI:1194417865
Name:MEDLEY, BIDDLE ROYAL JR
Entity type:Individual
Prefix:
First Name:BIDDLE
Middle Name:ROYAL
Last Name:MEDLEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6805 MAIN ST
Mailing Address - Street 2:STE 430 #673
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056
Mailing Address - Country:US
Mailing Address - Phone:817-521-1186
Mailing Address - Fax:
Practice Address - Street 1:3901 SAINT IVES LN
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-5092
Practice Address - Country:US
Practice Address - Phone:817-521-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X, 3416L0300X, 344600000X, 347C00000X
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle