MEDICARE: HIGH PLAINS HEALTH PROVIDERS

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		TX

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

General Provider Information

NPI Number	:	1912123472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH PLAINS HEALTH PROVIDERS

Provider Business Mailing Address
First Line	:	1505 P B LN
Second Line	:	SUITE A
City	:	WICHITA FALLS
State	:	TX
Zip	:	76302-2631
Country	:	US
Telephone Number	:	940-766-6751
Fax Number	:	940-766-6753

Provider Business Practice Location Address
First Line	:	4515 LAKE VIEW DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-3308
Country	:	US
Telephone Number	:	940-766-6751
Fax Number	:	940-766-6753

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GEORGE W CLAY IV
Credential	:
Telephone Number	:	940-766-6751

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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