MEDICARE: AIDS RESOURCES OF RURAL TEXAS

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	363LP2300X	Primary Care Nurse Practitioner	P44417	TX

General Provider Information

NPI Number	:	1932103991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIDS RESOURCES OF RURAL TEXAS

Provider Business Mailing Address
First Line	:	3116 N 1ST ST
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79603-7004
Country	:	US
Telephone Number	:	325-673-9987
Fax Number	:	325-673-9989

Provider Business Practice Location Address
First Line	:	3116 N 1ST ST
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79603-7004
Country	:	US
Telephone Number	:	325-673-9987
Fax Number	:	325-673-9989

Authorized Official
Title or Position	:	MEDICAL BILLING
Name	:	MRS. JOLENE GREENWOOD
Credential	:	MAB
Telephone Number	:	325-673-9987

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	08/22/2020

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