Basic Information
| Provider Information | |||||||||
| NPI: | 1821019035 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED REHAB SPECIALISTS OF DALLAS L. P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6807B WOODWAY DR | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767126146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2543990444 | ||||||||
| FaxNumber: | 2547720266 | ||||||||
| Practice Location | |||||||||
| Address1: | 4801 READING ST | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752476716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146589097 | ||||||||
| FaxNumber: | 2146589051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 09/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | HAGELSTEIN | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIRMAN OF THE BOARD | ||||||||
| AuthorizedOfficialTelephone: | 2543990444 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNITED REHAB SPECIALISTS, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 335E00000X | N | Suppliers | Prosthetic/Orthotic Supplier | 332BC3200X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
| ID | Type | State | Issuer | Description | 163838905 | 05 | TX | MEDICAID | 163838906 | 05 | TX | MEDICAID |