Provider Demographics
NPI:1861297814
Name:NEXUS MEDICAL SOURCE, INC.
Entity type:Organization
Organization Name:NEXUS MEDICAL SOURCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-557-2244
Mailing Address - Street 1:4176 TOCCATA UNIT 108
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0268
Mailing Address - Country:US
Mailing Address - Phone:682-557-2244
Mailing Address - Fax:
Practice Address - Street 1:202 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:GUNTER
Practice Address - State:TX
Practice Address - Zip Code:75058-2178
Practice Address - Country:US
Practice Address - Phone:682-557-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-14
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile