Provider Demographics
NPI:1124199369
Name:SPECIAL NEEDS SOLUTIONS, LLC
Entity Type:Organization
Organization Name:SPECIAL NEEDS SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCKOVER
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:903-330-0821
Mailing Address - Street 1:13213 HWY 155 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6561
Mailing Address - Country:US
Mailing Address - Phone:903-330-0821
Mailing Address - Fax:
Practice Address - Street 1:13213 HWY 155 S
Practice Address - Street 2:SUITE B
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6561
Practice Address - Country:US
Practice Address - Phone:903-330-0821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162607601Medicaid
TX162618602Medicaid
TX162618603Medicaid
TX162618606Medicaid
TX162618604Medicaid
TX531822OtherBLUECROSS BLUESHIELD
TX162618605Medicaid