Provider Demographics
NPI:1457376212
Name:BIG SPRING BACK REHAB & WELLNESS
Entity type:Organization
Organization Name:BIG SPRING BACK REHAB & WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WRAY
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:432-267-2915
Mailing Address - Street 1:1703 LANCASTER
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720
Mailing Address - Country:US
Mailing Address - Phone:432-263-2915
Mailing Address - Fax:432-267-3581
Practice Address - Street 1:1703 LANCASTER
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720
Practice Address - Country:US
Practice Address - Phone:432-263-2915
Practice Address - Fax:432-267-3581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456830Medicare ID - Type Unspecified