Basic Information
| Provider Information | |||||||||
| NPI: | 1669611448 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EPIC HEALTH SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EPIC PEDIATRIC THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1349 EMPIRE CENTRAL DR. | ||||||||
| Address2: | SUITE 1050 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144661340 | ||||||||
| FaxNumber: | 2144661378 | ||||||||
| Practice Location | |||||||||
| Address1: | 9440 VISCOUNT BLVD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799257049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9156299260 | ||||||||
| FaxNumber: | 9156299785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2009 | ||||||||
| LastUpdateDate: | 09/03/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GARBARINO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 2144661340 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 012426 | TX | N | Agencies | Home Health | 251E00000X | 12426-LICENSEDHCSSA | TX | N | Agencies | Home Health | 251E00000X | 015039 | TX | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 201694101 | 05 | TX | MEDICAID |