MEDICARE: HEALTH AND HUMAN SERVICES COMMISSION

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	3336I0012X	Institutional Pharmacy		TX
2	3336L0003X	Long Term Care Pharmacy	06005	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2098738	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174532220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH AND HUMAN SERVICES COMMISSION

Provider Business Mailing Address
First Line	:	1901 N US HIGHWAY 87
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-0283
Country	:	US
Telephone Number	:	432-268-7289
Fax Number	:	432-268-7245

Provider Business Practice Location Address
First Line	:	1901 N US HIGHWAY 87
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-0283
Country	:	US
Telephone Number	:	432-268-7289
Fax Number	:	432-268-7245

Authorized Official
Title or Position	:	PROGRAM SPECIALIST VI
Name	:	JANA JOHNSON
Credential	:
Telephone Number	:	512-438-3124

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/31/2019

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Directions to “HEALTH AND HUMAN SERVICES COMMISSION ” Practice Location

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