Basic Information
Provider Information | |||||||||
NPI: | 1114232931 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | EPIC HEALTH SERVICES, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | EPIC PEDIATRIC THERAPY | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1349 EMPIRE CENTRAL DR | ||||||||
Address2: | SUITE 1050 | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752474066 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2144661340 | ||||||||
FaxNumber: | 2144661378 | ||||||||
Practice Location | |||||||||
Address1: | 3721 EXECUTIVE CENTER DR | ||||||||
Address2: | SUITE 201 | ||||||||
City: | AUSTIN | ||||||||
State: | TX | ||||||||
PostalCode: | 787311645 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5123723777 | ||||||||
FaxNumber: | 5123723336 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/17/2010 | ||||||||
LastUpdateDate: | 07/17/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GARBARINO | ||||||||
AuthorizedOfficialFirstName: | JOHN | ||||||||
AuthorizedOfficialMiddleName: | C. | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
AuthorizedOfficialTelephone: | 2144661340 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 014924 | TX | Y |   | Agencies | Home Health |   |
ID Information
ID | Type | State | Issuer | Description | 025187801 | 05 | TX |   | MEDICAID |