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General NPI Number Information
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NPI Number | 1972654663
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Entity Type | Organization
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Legal Business Name | TEMPLE MEMORIAL PEDIATRIC CENTER INC.
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 1710 MOORES LN
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City | TEXARKANA
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State | TX
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Zip | 75503-1858
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Country | US
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Telephone | 903-794-2705
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Fax | 903-793-1203
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Provider Business Mailing Address
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Address Line | 1710 MOORES LN
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City | TEXARKANA
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State | TX
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Zip | 75503-1858
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Country | US
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Telephone | 903-794-2705
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Fax | 903-793-1203
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Authorized Official
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Title or Position | CEO
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Name | MRS. SANDRA K VARNER
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Credential |
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Telephone | 903-794-2705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 009425
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License Number State | TX
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