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 | 251E00000X | Home Health | | 009902 | TEXAS | Yes |
| 2 | 251J00000X | Nursing Care | | | | No |
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 | 87726 | OTHER | TEXAS | UNITEDHEALTHCARE MEDICARE ADVANTAGE |
| 2 | 014760 | OTHER | TEXAS | SUPERIOR HEALTHPLAN MEDICARE ADVANTAGE MMP |
| 3 | 185415002 | MEDICAID | TEXAS | |
| 4 | 185415003 | MEDICAID | TEXAS | |
| 5 | 284694 | OTHER | TEXAS | WELLCARE MEDICARE ADVANTAGE (VENDOR NUMBER) |
| 6 | QMP 000003404020 | OTHER | TEXAS | MOLINA - PHC / PAS |
| 7 | QMP 000003665470 | OTHER | TEXAS | MOLINA - MEDICARE ADVANTAGE |
| 8 | S50027809 | OTHER | TEXAS | SUPERIOR HEALTHPLAN - PHC / PAS |
| 9 | 001014993 | MEDICAID | TEXAS | |
| 10 | 001025665 | MEDICAID | TEXAS | |
| 11 | 014760 | OTHER | TEXAS | SUPERIOR HELATHPLAN MEDICARE ADVANTAGE ALLWELL BY SUPERIOR |
| 12 | 531186 | OTHER | TEXAS | WELLCARE MEDICARE ADVANTAGE (PROVIDER NUMBER) |
| 13 | 0049572-S | OTHER | TEXAS | WELLMED MEDICARE ADVANTAGE |
| 14 | 81400 | OTHER | TEXAS | UNITEDHEALTHCARE MEDICARE ADVANTAGE ALL SAVERS |
| 15 | 1750542320 | OTHER | TEXAS | MYNEXUS MEDICARE ADVANTAGE |
| 16 | 58634-0001 | OTHER | TEXAS | COMMUNITY FIRST CHOICE STARPLUS PHC/PAS |
| 17 | 10055790 | OTHER | TEXAS | AMERIGROUP - PHC / PAS |
| 18 | 10055790 | OTHER | TEXAS | AMERIGROUP MEDICARE ADVANTAGE MMP |
