Basic Information
| Provider Information | |||||||||
| NPI: | 1831304633 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST TEXAS REHABILITATION CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 HARTFORD ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796054603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3257933400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3001 S JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANGELO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 769045129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3252236300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 02/26/2018 | ||||||||
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| AuthorizedOfficialLastName: | CHILDS | ||||||||
| AuthorizedOfficialFirstName: | TIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3257933400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 261QH0700X | N | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | 261QR0401X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | 332S00000X | N | Suppliers | Hearing Aid Equipment | 237700000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 137920806 | 05 | TX | MEDICAID |