Provider Demographics
NPI:1215414636
Name:KREIS MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:KREIS MEDICAL SERVICES LLC
Other - Org Name:SIEGFRIED KREIS
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIEGFRIED
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KREIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-744-7114
Mailing Address - Street 1:PO BOX 23148
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-3148
Mailing Address - Country:US
Mailing Address - Phone:254-744-7114
Mailing Address - Fax:
Practice Address - Street 1:106 STAR RIDGE CIR
Practice Address - Street 2:
Practice Address - City:MC GREGOR
Practice Address - State:TX
Practice Address - Zip Code:76657
Practice Address - Country:US
Practice Address - Phone:254-744-7114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2141261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113418101Medicaid