Provider Demographics
NPI:1336334515
Name:NIGHTINGALE PROVIDER SERVICES INC.
Entity type:Organization
Organization Name:NIGHTINGALE PROVIDER SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IGNAY
Authorized Official - Middle Name:O
Authorized Official - Last Name:NWOFIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-509-4440
Mailing Address - Street 1:1405 S FLEISHEL AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3345
Mailing Address - Country:US
Mailing Address - Phone:903-509-4440
Mailing Address - Fax:903-534-8999
Practice Address - Street 1:1405 S FLEISHEL AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3345
Practice Address - Country:US
Practice Address - Phone:903-509-4440
Practice Address - Fax:903-534-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747287Medicare PIN