Healthcare Provider Details

I. General information

NPI: 1669801585
Provider Name (Legal Business Name): REGIONAL EMPLOYEE ASSISTANCE PROGRAM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S GREGG ST
BIG SPRING TX
79720-5531
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 432-466-2000
  • Fax: 432-268-1010
Mailing address:
  • Phone: 866-398-7107
  • Fax: 615-465-2879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SOPHIA L ARWOOD
Title or Position: DIRECTOR
Credential:
Phone: 615-628-6038