MEDICARE: FE DEERE INC.

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1437155025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FE DEERE INC.

Provider Business Mailing Address
First Line	:	4838 HOLLY RD
Second Line	:	STE 201
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-4754
Country	:	US
Telephone Number	:	361-991-9021
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 CEDAR DR
Second Line	:
City	:	PORTLAND
State	:	TX
Zip	:	78374-2900
Country	:	US
Telephone Number	:	361-643-1888
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. FRANCIS E DEERE
Credential	:
Telephone Number	:	361-991-9021

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/17/2007

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Directions to “FE DEERE INC. ” Practice Location

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