Provider Demographics
NPI:1992820310
Name:KIDS ROUND UP PEDIATRIC REHAB LLC
Entity type:Organization
Organization Name:KIDS ROUND UP PEDIATRIC REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-COMPTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-361-5437
Mailing Address - Street 1:1821 S SESAME SQ STE 1
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7941
Mailing Address - Country:US
Mailing Address - Phone:956-361-5437
Mailing Address - Fax:956-361-5440
Practice Address - Street 1:1821 S SESAME SQ STE 1
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7941
Practice Address - Country:US
Practice Address - Phone:956-361-5437
Practice Address - Fax:956-361-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178224501Medicaid