Provider Demographics
NPI:1215034665
Name:SELECT REHAB OF EAST TEXAS, INC.
Entity Type:Organization
Organization Name:SELECT REHAB OF EAST TEXAS, INC.
Other - Org Name:SELECT MEDICAL OF EAST TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-234-2444
Mailing Address - Street 1:802 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5378
Mailing Address - Country:US
Mailing Address - Phone:903-234-2444
Mailing Address - Fax:903-234-1868
Practice Address - Street 1:802 N HIGH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5378
Practice Address - Country:US
Practice Address - Phone:903-234-2444
Practice Address - Fax:903-234-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX530610OtherBLUE CROSS BLUE SHIELD
TX530610OtherBLUE CROSS BLUE SHIELD