Basic Information
| Provider Information | |||||||||
| NPI: | 1871699389 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERCY REHAB SERVICES INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MERCY KIDS REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2335 E SAUNDERS ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780415434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567914800 | ||||||||
| FaxNumber: | 9567914422 | ||||||||
| Practice Location | |||||||||
| Address1: | 2335 E SAUNDERS ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780415434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567914800 | ||||||||
| FaxNumber: | 9567914422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 01/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | TURRUBIATES | ||||||||
| AuthorizedOfficialFirstName: | MARCO | ||||||||
| AuthorizedOfficialMiddleName: | ANTONIO | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9564286800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0401X | 552780000 655900000 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
ID Information
| ID | Type | State | Issuer | Description | 172237303 | 05 | TX | MEDICAID |