Provider Demographics
NPI:1093778805
Name:MJF REHABILITATION PA
Entity Type:Organization
Organization Name:MJF REHABILITATION PA
Other - Org Name:PROFESSIONAL ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRELLE
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-315-2106
Mailing Address - Street 1:PO BOX 290142
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-0142
Mailing Address - Country:US
Mailing Address - Phone:830-315-2106
Mailing Address - Fax:830-315-2108
Practice Address - Street 1:551 HILL COUNTRY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6085
Practice Address - Country:US
Practice Address - Phone:830-315-2106
Practice Address - Fax:830-315-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3966208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152698001Medicaid
TX008PZOtherBLUE CROSS BLUE SHIELD
H58939Medicare UPIN
TX008PZOtherBLUE CROSS BLUE SHIELD