Provider Demographics
NPI:1285678490
Name:CENTRAL LINE INFUSION DALLAS DIVISION LTD
Entity type:Organization
Organization Name:CENTRAL LINE INFUSION DALLAS DIVISION LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:KATEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-477-7375
Mailing Address - Street 1:PO BOX 223017
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-2017
Mailing Address - Country:US
Mailing Address - Phone:800-477-7375
Mailing Address - Fax:877-676-0493
Practice Address - Street 1:8080 TRISTAR DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2823
Practice Address - Country:US
Practice Address - Phone:972-815-0460
Practice Address - Fax:972-915-3841
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERITA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23275332B00000X, 332BP3500X, 3336H0001X
335G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335G00000XSuppliersMedical Foods Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1285678490Medicaid
TX23275OtherBOARD OF PHARMACY
TX4531352OtherNCPDP
BC7422950OtherDEA
TX169477001Medicaid
TX4531352OtherNCPDP