Provider Demographics
NPI:1629023981
Name:ABILENE REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:ABILENE REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL LABORATORY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DUSKY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-691-2416
Mailing Address - Street 1:6250 HIGHWAY 83/84
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606
Mailing Address - Country:US
Mailing Address - Phone:325-691-2416
Mailing Address - Fax:325-691-2483
Practice Address - Street 1:6250 HIGHWAY 83/84
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606
Practice Address - Country:US
Practice Address - Phone:325-691-2416
Practice Address - Fax:325-691-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112705203Medicaid
TX112705203Medicaid