Basic Information
| Provider Information | |||||||||
| NPI: | 1336190289 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INPATIENT REHABILITATION SPECIALISTS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 678114 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752678114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143457456 | ||||||||
| FaxNumber: | 2143454152 | ||||||||
| Practice Location | |||||||||
| Address1: | 8200 WALNUT HILL LN | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752314426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143457456 | ||||||||
| FaxNumber: | 2143454152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 10/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2145667766 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 00619V | 01 | TX | BCBS | OTHER | 161160001 | 05 | TX | MEDICAID |