Provider Demographics
NPI:1730378126
Name:FOREST L CALHOUN JR
Entity type:Organization
Organization Name:FOREST L CALHOUN JR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FOREST
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:817-292-1622
Mailing Address - Street 1:5709 WESTCREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-3301
Mailing Address - Country:US
Mailing Address - Phone:817-292-1622
Mailing Address - Fax:817-423-2313
Practice Address - Street 1:5709 WESTCREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-3301
Practice Address - Country:US
Practice Address - Phone:817-292-1622
Practice Address - Fax:817-423-2313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1914483 01Medicaid
TX0911420001Medicare NSC