Basic Information
Provider Information | |||||||||
NPI: | 1780685396 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | TEXAS MEDICAL SERVICE, LP | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HOSPICE OF TEXAS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2900 NORTH ST | ||||||||
Address2: | SUITE 100 | ||||||||
City: | BEAUMONT | ||||||||
State: | TX | ||||||||
PostalCode: | 77702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4098324582 | ||||||||
FaxNumber: | 4098326345 | ||||||||
Practice Location | |||||||||
Address1: | 2900 NORTH ST | ||||||||
Address2: | SUITE 100 | ||||||||
City: | BEAUMONT | ||||||||
State: | TX | ||||||||
PostalCode: | 77702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4098324582 | ||||||||
FaxNumber: | 4098326345 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/04/2005 | ||||||||
LastUpdateDate: | 09/17/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PARRISH | ||||||||
AuthorizedOfficialFirstName: | LELA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
AuthorizedOfficialTelephone: | 4098324582 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | LMSW | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 008361 | TX | Y |   | Agencies | Hospice Care, Community Based |   |
ID Information
ID | Type | State | Issuer | Description | HH6887 | 01 | TX | BCBS OF TEXAS | OTHER | 001004553 | 05 | TX |   | MEDICAID |