Provider Demographics
NPI:1174577621
Name:FIFTY50 FOODS LP
Entity type:Organization
Organization Name:FIFTY50 FOODS LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-243-2727
Mailing Address - Street 1:1420 VALWOOD PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-8312
Mailing Address - Country:US
Mailing Address - Phone:972-243-2727
Mailing Address - Fax:972-243-3111
Practice Address - Street 1:1420 VALWOOD PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-8312
Practice Address - Country:US
Practice Address - Phone:972-243-2727
Practice Address - Fax:972-243-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0086459332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014330701Medicaid
TX0872600001Medicare ID - Type UnspecifiedMEDICARE PART B