Provider Demographics
NPI:1336109859
Name:BUNKER & EILAND PC
Entity Type:Organization
Organization Name:BUNKER & EILAND PC
Other - Org Name:PHYSICAL THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT SCS
Authorized Official - Phone:888-590-4002
Mailing Address - Street 1:5407 NEW COPELAND RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3951
Mailing Address - Country:US
Mailing Address - Phone:903-597-3386
Mailing Address - Fax:903-531-2241
Practice Address - Street 1:5407 NEW COPELAND RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3951
Practice Address - Country:US
Practice Address - Phone:903-597-3386
Practice Address - Fax:903-531-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX602160000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080550901Medicaid
TX84381TOtherBCBS OF TX
TX021694701OtherMEDICAID
TX84382TOtherBCBS OF TX
TX080550901Medicaid