Provider Demographics
NPI:1215933833
Name:CHEST DIAGNOSTIC THERAPEUTIC SERVICES, INC
Entity type:Organization
Organization Name:CHEST DIAGNOSTIC THERAPEUTIC SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:WRAGGE
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:254-562-3803
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-0289
Mailing Address - Country:US
Mailing Address - Phone:254-562-3803
Mailing Address - Fax:254-562-2372
Practice Address - Street 1:601A W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:TX
Practice Address - Zip Code:75840-1425
Practice Address - Country:US
Practice Address - Phone:903-389-7368
Practice Address - Fax:903-389-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0056144332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX531256OtherBCBS PROVIDER NUMBER
TX531256OtherBCBS PROVIDER NUMBER
TX531256OtherBCBS PROVIDER NUMBER