MEDICARE: BIG SPRING BACK REHAB & WELLNESS

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	261QR0400X	Rehabilitation Clinic/Center		TX

General Provider Information

NPI Number	:	1457376212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIG SPRING BACK REHAB & WELLNESS

Provider Business Mailing Address
First Line	:	1703 LANCASTER
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720
Country	:	US
Telephone Number	:	432-263-2915
Fax Number	:	432-267-3581

Provider Business Practice Location Address
First Line	:	1703 LANCASTER
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720
Country	:	US
Telephone Number	:	432-263-2915
Fax Number	:	432-267-3581

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES WRAY WARREN
Credential	:	DC
Telephone Number	:	432-267-2915

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	08/22/2020

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