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Get TX DADS 3681 2011-2024

Ction 2. Applicant’s Legal Entity Information Name of Legal Entity Doing Business As (d/b/a), if applicable Taxpayer Identification No. (EIN or SSN) Provider Identifier No. (NPI or API) First Name of Owner (if legal entity is a sole proprietorship) MI Last Name Jr., Sr., etc. Legal Entity Business Mailing Address (Street or P.O. Box, City, State, ZIP Code) Legal Entity Physical Address (Street, City, State, ZIP Code), if different from mailing address Location Where Service Delivery Re.

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