Provider Demographics
NPI:1114038254
Name:WORKERS INJURY MANAGEMENT AND EVALUATION SERVICES, P.A.
Entity Type:Organization
Organization Name:WORKERS INJURY MANAGEMENT AND EVALUATION SERVICES, P.A.
Other - Org Name:OCCUPATIONAL ORTHOPAEDICS AND SPINAL SPECIALISTS P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:EAST-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-857-4021
Mailing Address - Street 1:1981 S. OLD TEMPLE ROAD
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655
Mailing Address - Country:US
Mailing Address - Phone:254-857-4021
Mailing Address - Fax:254-857-4391
Practice Address - Street 1:1981 S. OLD TEMPLE ROAD
Practice Address - Street 2:
Practice Address - City:LORENA
Practice Address - State:TX
Practice Address - Zip Code:76655
Practice Address - Country:US
Practice Address - Phone:254-857-4021
Practice Address - Fax:254-857-4391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2502207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34031701Medicaid
TXC25133Medicare UPIN
TX34031701Medicaid