Provider Demographics
| NPI: | 1144277674 |
|---|---|
| Name: | MEDCARE PEDIATRIC REHAB CENTER, LP |
| Entity type: | Organization |
| Organization Name: | MEDCARE PEDIATRIC REHAB CENTER, LP |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO - ADMINISTRATOR |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | PAIGE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | KINKADE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 713-773-5100 |
| Mailing Address - Street 1: | 12371 S KIRKWOOD RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | STAFFORD |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 77477-2836 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 713-773-5100 |
| Mailing Address - Fax: | 713-773-5151 |
| Practice Address - Street 1: | 12371 S KIRKWOOD RD |
| Practice Address - Street 2: | |
| Practice Address - City: | STAFFORD |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 77477 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 713-995-9292 |
| Practice Address - Fax: | 281-207-0659 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | MEDCARE PEDIATRIC GROUP, LP |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-05-29 |
| Last Update Date: | 2021-11-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| TX | 45-4876 | 261QR0401X |
| TX | 24726 | 235Z00000X |
| TX | 103259 | 235Z00000X |
| TX | 1073955 | 2251P0200X |
| TX | 1141232 | 2251P0200X |
| TX | 2043750 | 225200000X |
| TX | 363621 | 1041C0700X |
| TX | 208657 | 224Z00000X |
| TX | 208569 | 224Z00000X |
| TX | 111014 | 225XP0200X |
| TX | 111898 | 225XP0200X |
| TX | 100657 | 235Z00000X |
| TX | 1161240 | 2251P0200X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Single Specialty |
| Yes | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | Group - Single Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty | |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Single Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Single Specialty |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Single Specialty | |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Single Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 1801326-01 | Medicaid | |
| TX | 1801326-01 | Medicaid | |
| TX | 45-4876 | Medicare Oscar/Certification |
