Provider Demographics
NPI:1063707321
Name:MKSON, INC
Entity type:Organization
Organization Name:MKSON, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLIVE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANYANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-217-9967
Mailing Address - Street 1:PO BOX 542222
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75354-2222
Mailing Address - Country:US
Mailing Address - Phone:214-217-9967
Mailing Address - Fax:214-351-5559
Practice Address - Street 1:2351 W NORTHWEST HWY STE 1215
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-8415
Practice Address - Country:US
Practice Address - Phone:214-217-9967
Practice Address - Fax:214-351-5559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MKSON, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health