Provider Demographics
NPI:1841485307
Name:SSR MEDICAL TEMPS, LLC
Entity type:Organization
Organization Name:SSR MEDICAL TEMPS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEATHERAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-482-2450
Mailing Address - Street 1:1712 N FRAZIER ST
Mailing Address - Street 2:213
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1347
Mailing Address - Country:US
Mailing Address - Phone:832-482-2450
Mailing Address - Fax:832-550-2075
Practice Address - Street 1:1712 N FRAZIER ST
Practice Address - Street 2:213
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1347
Practice Address - Country:US
Practice Address - Phone:832-482-2450
Practice Address - Fax:832-550-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011339251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health