Provider Demographics
NPI:1043213804
Name:INDEPENDENCE REHAB EQUIPMENT INC.
Entity Type:Organization
Organization Name:INDEPENDENCE REHAB EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-832-9770
Mailing Address - Street 1:8844 TRADEWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6115
Mailing Address - Country:US
Mailing Address - Phone:210-832-9770
Mailing Address - Fax:210-832-0010
Practice Address - Street 1:8844 TRADEWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6115
Practice Address - Country:US
Practice Address - Phone:210-832-9770
Practice Address - Fax:210-832-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QA3000XAmbulatory Health Care FacilitiesClinic/CenterAugmentative Communication
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4374060001Medicare ID - Type Unspecified