Provider Demographics
NPI:1073103172
Name:INTERIM HEALTHCARE OF WEST TEXAS LLC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF WEST TEXAS LLC
Other - Org Name:INTERIM HEALTHCARE OF BIG SPRING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:806-771-0995
Mailing Address - Street 1:3223 S LOOP 289 STE 210
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1352
Mailing Address - Country:US
Mailing Address - Phone:806-771-0588
Mailing Address - Fax:806-687-5966
Practice Address - Street 1:1900 S GREGG ST STE C
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5462
Practice Address - Country:US
Practice Address - Phone:432-235-1164
Practice Address - Fax:432-235-1169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157152301Medicaid