Provider Demographics
NPI:1295769222
Name:ERIK M HAGER THE KIDS SPOT PEDIATRIC REHAB
Entity type:Organization
Organization Name:ERIK M HAGER THE KIDS SPOT PEDIATRIC REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER OTR
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAGER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:956-412-6060
Mailing Address - Street 1:512 VICTORIA LANE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550
Mailing Address - Country:US
Mailing Address - Phone:956-412-6060
Mailing Address - Fax:956-412-6070
Practice Address - Street 1:640 S EXPRESSWAY 77
Practice Address - Street 2:SUITE 3
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-4240
Practice Address - Country:US
Practice Address - Phone:956-412-6060
Practice Address - Fax:956-412-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0400X
TX554150000-658290000261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0046NN BC/BSOtherPEDIATRIC REHABILITATION
TX1787095-01Medicaid
TX00994Z PART BMedicare ID - Type UnspecifiedPEDIATRIC REHABILITATION
TX0046NN BC/BSOtherPEDIATRIC REHABILITATION