MEDICARE: RENAISSANCE OUTPATIENT REHABILITATION CENTER, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	225100000X	Physical Therapist
3	225X00000X	Occupational Therapist
4	227900000X	Registered Respiratory Therapist
5	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0018EX	OTHER	TX	BC/BS PROVIDER ID

General Provider Information

NPI Number	:	1235137506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE OUTPATIENT REHABILITATION CENTER, LLC.

Provider Business Mailing Address
First Line	:	PO BOX 720157
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-0157
Country	:	US
Telephone Number	:	956-682-6900
Fax Number	:	956-682-8445

Provider Business Practice Location Address
First Line	:	910 E 8TH ST STE 7
Second Line	:
City	:	WESLACO
State	:	TX
Zip	:	78596-4346
Country	:	US
Telephone Number	:	956-702-9882
Fax Number	:	956-702-9886

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	JOSE R CARRERAS
Credential	:	M.D.
Telephone Number	:	956-682-6900

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/16/2014

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Directions to “RENAISSANCE OUTPATIENT REHABILITATION CENTER, LLC. ” Practice Location

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