MEDICARE: TEXAS UNITED ENERGY WORKERS HEALTHCARE LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1205373271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS UNITED ENERGY WORKERS HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	614 E MAIN ST STE C
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-4460
Country	:	US
Telephone Number	:	435-459-4407
Fax Number	:

Provider Business Practice Location Address
First Line	:	6666 W AMARILLO BLVD
Second Line	:	#17
City	:	AMARILLO
State	:	TX
Zip	:	79106-1756
Country	:	US
Telephone Number	:	435-459-4407
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	TRAVIS SHUMWAY
Credential	:
Telephone Number	:	435-459-4407

Provider Enumeration Date	:	01/27/2017
Last Update Date	:	01/27/2017

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