1184867152 NPI number — RGA HEALTHCARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184867152 NPI number — RGA HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RGA HEALTHCARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RGA HOMECARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184867152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1411 CHICO HWY
Provider Second Line Business Mailing Address:
P O BOX 667
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76426-2213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-627-4574
Provider Business Mailing Address Fax Number:
940-683-2691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2304 MIDWESTERN PKWY
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
WICHITA FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76308-2342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-687-8850
Provider Business Practice Location Address Fax Number:
940-687-8851
Provider Enumeration Date:
04/07/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AMMONS
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
940-627-4574

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)