Provider Demographics
NPI:1720483696
Name:PROFESSIONAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTH SERVICES INC
Other - Org Name:HUMAN PERFORMANCE AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:325-695-4244
Mailing Address - Street 1:4351 RIDGEMONT DR
Mailing Address - Street 2:STE C
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-8746
Mailing Address - Country:US
Mailing Address - Phone:325-695-4244
Mailing Address - Fax:325-698-4547
Practice Address - Street 1:4351 RIDGEMONT DR
Practice Address - Street 2:STE C
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8746
Practice Address - Country:US
Practice Address - Phone:325-695-4244
Practice Address - Fax:325-698-4547
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFESSIONAL HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-04
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456687Medicare PIN