1639342017 NPI number — DELTA REHABILITATION SERVICES, P.C.

Table of content: (NPI 1639342017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639342017 NPI number — DELTA REHABILITATION SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELTA REHABILITATION SERVICES, P.C.
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:
Provider Other Organization Name Type Code:
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:
1639342017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18618
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77496-8618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-804-0612
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 19
Provider Business Practice Location Address City Name:
ROSENBERG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77471-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-431-5623
Provider Business Practice Location Address Fax Number:
866-215-0355
Provider Enumeration Date:
04/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HAMID
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-804-0612

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1082881 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1766347 01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 721311 . This is a "ALIGN NETWORKS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 721311 . This is a "EVERCARE MP PROGRAM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 48KM . This is a "BCBS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8F24409 . This is a "MEDICARE INDIVIDUAL PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: OA6219 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 721311 . This is a "UNITED MEDICAL RESOURCES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 721311 . This is a "UNIVERSAL SMARTCOMP WORKERS' COMPENSATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 721311 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 721311 . This is a "MEDRISK WORKERS' COMPENSATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 721311 . This is a "WORKERS COMPENSATION NETWORK FOR INTEGRATED HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 721311 . This is a "TEXAS STAR-PLUS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 721311 . This is a "CYPRESSCARE WORKERS COMPENSATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8T1541 . This is a "BCBS INDIVIDUAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 721311 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 721311 . This is a "WORKERS COMPENSATION NETWORK FOR HEALTH SYSTEMS INTERNATIONAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 721311 . This is a "WORKERS COMPENSATION NETWORK FOR ROCKPORT HEALTHCARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 721311 . This is a "RESERVE NATIONAL INSURANCE COMPANY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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