Provider Demographics
NPI:1346315207
Name:AIDS RESOURCES OF RURAL TEXAS
Entity Type:Organization
Organization Name:AIDS RESOURCES OF RURAL TEXAS
Other - Org Name:ARRT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ED
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-673-9987
Mailing Address - Street 1:3116 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-7004
Mailing Address - Country:US
Mailing Address - Phone:325-673-9987
Mailing Address - Fax:325-673-9989
Practice Address - Street 1:250 SANTA FE DR
Practice Address - Street 2:SUITE # 101
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6585
Practice Address - Country:US
Practice Address - Phone:325-673-9987
Practice Address - Fax:325-673-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
TX651762363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148675501Medicaid
TX148675501Medicaid