Meadow Creek SCC LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MEADOW CREEK SCC LLC

Practice address

4343 Oak Grove Blvd.
San Angelo, TX 76904-4500

Phone

(325) 949-2559

Fax

(325) 949-3598

NPI assigned

Oct 18, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Beal

Title

Chief Executive Officer

Phone

(214) 252-7600

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Senior Care of Meadow Creek Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1382054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583280000000",
    "number": "1336577873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N PEARL ST STE 1050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752017495",
            "telephone_number": "214-252-7600",
            "fax_number": "214-252-7704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 OAK GROVE BLVD.",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769044500",
            "telephone_number": "325-949-2559",
            "fax_number": "325-949-3598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOW CREEK SCC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-18",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A",
        "authorized_official_last_name": "BEAL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "214-252-7600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001025585",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Senior Care of Meadow Creek",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Senior Care of Meadow Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tyesha Raenett McMurrian, COTA/L
• Carole Jane McNabb
• Winston Steve McQueen Robalino, M.D
• Tim P McQueen, D.D.S.
• Karen D McSpadden, PT
• Med Southwest, PLLC
• Med-Trans Corporation
• Med-Trans Corporation
• Medhab
• Medical Alliance Group of Texas, LLC

• Skilled Nursing Facility in San Angelo, TX
• Providers in San Angelo, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.