Healthcare Provider Details

I. General information

NPI: 1720483696
Provider Name (Legal Business Name): PROFESSIONAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 RIDGEMONT DR STE C
ABILENE TX
79606-8746
US

IV. Provider business mailing address

4351 RIDGEMONT DR STE C
ABILENE TX
79606-8746
US

V. Phone/Fax

Practice location:
  • Phone: 325-695-4244
  • Fax: 325-698-4547
Mailing address:
  • Phone: 325-695-4244
  • Fax: 325-698-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH G. LAIN
Title or Position: PRESIDENT / ADMINISTRATOR
Credential: PHD
Phone: 325-695-4244