Provider Demographics
NPI:1821061532
Name:ENCOMPASS HEALTH REHABILITATION HOSPITAL OF MIDLAND ODESSA, LLC
Entity Type:Organization
Organization Name:ENCOMPASS HEALTH REHABILITATION HOSPITAL OF MIDLAND ODESSA, LLC
Other - Org Name:ENCOMPASS HEALTH REHABILITATION HOSPITAL OF MIDLAND ODESSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:WISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-970-5702
Mailing Address - Street 1:9001 LIBERTY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7509
Mailing Address - Country:US
Mailing Address - Phone:205-967-7116
Mailing Address - Fax:205-969-6650
Practice Address - Street 1:1800 HERITAGE BLVD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707
Practice Address - Country:US
Practice Address - Phone:432-520-1600
Practice Address - Fax:432-520-1704
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCOMPASS HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX693283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
HH0951OtherBLUE CROSS
TXH04530579Medicaid
HH0951OtherBLUE CROSS