1851578892 NPI number — SEARS CAPROCK RETIREMENT CORPORATION

Table of content: (NPI 1851578892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851578892 NPI number — SEARS CAPROCK RETIREMENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEARS CAPROCK RETIREMENT CORPORATION
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:
MESA SPRINGS HEALTHCARE
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:
1851578892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 VILLAGE DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79606-8231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-691-5519
Provider Business Mailing Address Fax Number:
325-698-4582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7171 BUFFALO GAP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79606-5450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-691-5519
Provider Business Practice Location Address Fax Number:
325-698-4582
Provider Enumeration Date:
01/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
SENIOR VICE PRESIDENT/CFO
Authorized Official Telephone Number:
325-691-5519

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001015958 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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