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 | 261QR1300X | Clinic/Center | Rural Health | 000102 | TEXAS | No |
| 2 | 282NC0060X | General Acute Care Hospital | Critical Access | 000102 | TEXAS | 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 | 091847602 | MEDICAID | TEXAS | |
| 2 | 184188401 | MEDICAID | TEXAS | |
| 3 | 458218 | MEDICARE ID-TYPE UNSPECIFIED | TEXAS | HOME HEALTH |
| 4 | 45Z352 | MEDICARE OSCAR/CERTIFICATION | TEXAS | |
| 5 | 00K25Q | MEDICARE ID-TYPE UNSPECIFIED | TEXAS | MEDICARE PART B |
| 6 | 023961801 | MEDICAID | TEXAS | |
| 7 | 458830 | MEDICARE ID-TYPE UNSPECIFIED | TEXAS | RURAL HEALTH CLINIC |
| 8 | 121692107 | MEDICAID | TEXAS | |
| 9 | 451352 | MEDICARE ID-TYPE UNSPECIFIED | TEXAS | CRITICAL CARE HOSPIAL |
| 10 | 121692106 | MEDICAID | TEXAS | |
