MEDICARE: WICHITA VALLEY REHABILITATION HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283X00000X	Rehabilitation Hospital	007229	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HH1000	OTHER		BCBS

General Provider Information

NPI Number	:	1073595948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WICHITA VALLEY REHABILITATION HOSPITAL

Provider Business Mailing Address
First Line	:	302 LOOP 11
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76306-3705
Country	:	US
Telephone Number	:	940-397-8200
Fax Number	:	940-397-8240

Provider Business Practice Location Address
First Line	:	302 LOOP 11
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76306-3705
Country	:	US
Telephone Number	:	940-397-8200
Fax Number	:	940-397-8240

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DELNITA BRAY
Credential	:
Telephone Number	:	940-397-8200

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/22/2020

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