1952625048 NPI number — EPIC HEALTH SERVICES, INC.

Table of content: (NPI 1952625048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952625048 NPI number — EPIC HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
EPIC HEALTH SERVICES, INC.
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:
EPIC PEDIATRIC THERAPY
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:
1952625048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5220 SPRING VALLEY RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75254-3099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-466-1340
Provider Business Mailing Address Fax Number:
214-466-1378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 WEST US HIGHWAY 83
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
569-510-8777
Provider Business Practice Location Address Fax Number:
954-854-4338
Provider Enumeration Date:
03/18/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROUSSOS
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
214-466-1340

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 13323-LICENSEDHCSSA , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 014807 , 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)

  • Identifier: 218020001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".