Provider Demographics
NPI:1255315446
Name:SEARS METHODIST CENTER, INC
Entity Type:Organization
Organization Name:SEARS METHODIST CENTER, INC
Other - Org Name:SEARS METHODIST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/ASST. CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:325-691-5519
Mailing Address - Street 1:1 VILLAGE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-8231
Mailing Address - Country:US
Mailing Address - Phone:325-691-5519
Mailing Address - Fax:325-698-4582
Practice Address - Street 1:3202 S WILLIS ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-6650
Practice Address - Country:US
Practice Address - Phone:325-692-6145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15258333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350020Medicaid