Basic Information
Provider Information | |||||||||
NPI: | 1588647226 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | UNITED REHAB SPECIALISTS, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6807B WOODWAY DR | ||||||||
Address2: |   | ||||||||
City: | WACO | ||||||||
State: | TX | ||||||||
PostalCode: | 767126146 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2543990444 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 6807B WOODWAY DR | ||||||||
Address2: |   | ||||||||
City: | WACO | ||||||||
State: | TX | ||||||||
PostalCode: | 767126146 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2543990444 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/28/2005 | ||||||||
LastUpdateDate: | 02/24/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HAGELSTEIN | ||||||||
AuthorizedOfficialFirstName: | RICK | ||||||||
AuthorizedOfficialMiddleName: | ROBISON | ||||||||
AuthorizedOfficialTitleorPosition: | CHAIRMAN OF THE BOARD | ||||||||
AuthorizedOfficialTelephone: | 2543990444 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: | SR. | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | 0073075 | TX | N |   | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332BP3500X | 0073075 | TX | N |   | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 335E00000X |   |   | N |   | Suppliers | Prosthetic/Orthotic Supplier |   | 332B00000X | 0073075 | TX | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
ID Information
ID | Type | State | Issuer | Description | 163838904 | 05 | TX |   | MEDICAID | 163838901 | 05 | TX |   | MEDICAID | 163838903 | 05 | TX |   | MEDICAID | 163838902 | 05 | TX |   | MEDICAID |