CUSTOM REHAB OF SOUTH TEXAS INC. NPI 1700930633

NPI Information

NPI: 1700930633
Provider Name: CUSTOM REHAB OF SOUTH TEXAS, INC.
Classification: Durable Medical Equipment & Medical Supplies - 332BC3200X
Entity Type: Organization

Specialization: Customized Equipment

Address:
12907 HIGHWAY 36
NEEDVILLE, TX
ZIP 77461
Phone: (979) 793-7570
Get Directions

CUSTOM REHAB OF SOUTH TEXAS, INC. is a customized equipment durable medical equipment medical supplies in Needville, TX. CUSTOM REHAB OF SOUTH TEXAS, INC. NPI is 1700930633. The provider is registered as an organization entity type.

The provider's business location address is:

12907 HIGHWAY 36
NEEDVILLE, TX
ZIP 77461
Phone: (979) 793-7570
Fax: (979) 793-5540

The provider's authorized official is Lorena Matthiesen .
The authorized official title is President and has the following contact phone number (979) 793-7570.

The enumeration date for this NPI number is 1/22/2007 and was last updated on 7/7/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332B00000X	Durable Medical Equipment & Medical Supplies				No
2	332BC3200X	Durable Medical Equipment & Medical Supplies	Customized Equipment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	519066	OTHER	TEXAS	BLUE CROSS BLUE SHIELD
2	010008301	MEDICAID	TEXAS
3	0908380001	MEDICARE NSC	TEXAS
4	10023796	OTHER	TEXAS	AMERIGROUP PROVIDER #
5	011390401	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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