1023013448 NPI number — UNITED REGIONAL HEALTH CARE SYSTEM INC

Table of content: (NPI 1023013448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023013448 NPI number — UNITED REGIONAL HEALTH CARE SYSTEM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED REGIONAL HEALTH CARE SYSTEM 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:
Provider Other Organization Name Type Code:
6
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:
1023013448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 11TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA FALLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76301-4388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-764-3034
Provider Business Mailing Address Fax Number:
940-764-8315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 11TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76301-4388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-764-3034
Provider Business Practice Location Address Fax Number:
940-764-8315
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EDMONDSON
Authorized Official First Name:
CORY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
940-764-3034

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 000417 , 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: 135237904 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135237905 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135237906 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303401 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP30169 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP40169 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00L72S . This is a "BLUE CROSS HOSP BASED PHY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10649B , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135237907 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0128 . This is a "BLUE CROSS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100702600A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23340 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100103590A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 408086137 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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