Provider Demographics
NPI:1104964238
Name:TEMPLE HEALTHCARE, INC
Entity type:Organization
Organization Name:TEMPLE HEALTHCARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-653-1077
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-0422
Mailing Address - Country:US
Mailing Address - Phone:325-653-1077
Mailing Address - Fax:325-653-1077
Practice Address - Street 1:1313 S 1ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-5762
Practice Address - Country:US
Practice Address - Phone:254-773-4309
Practice Address - Fax:254-773-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143523201Medicaid
TX143522401Medicaid
TX503791OtherBLUE CROSS & BLUE SHIELD
TX143522401Medicaid
TX503791OtherBLUE CROSS & BLUE SHIELD