=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629153978
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUSH AND MIKE WHEELER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2613 34TH ST
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79410-3519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-792-2196
-----------------------------------------------------
Fax | 806-792-7740
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2613 34TH ST
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79410-3519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-792-2196
-----------------------------------------------------
Fax | 806-792-7740
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADM/OWNER
-----------------------------------------------------
Name | MR. RUSH MIKE WHEELER
-----------------------------------------------------
Credential | OWNER
-----------------------------------------------------
Telephone | 806-792-2196
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | 115604
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------