Active NPI
Jackie (Jack) Duwayne Rurak, ATP #64040
- Other Technician
- Cleburne, TX
National Provider Identifier
1730502279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- Practice address
- 604 N Nolan River Rd
Cleburne, TX 76033-7008 - Phone
- (817) 645-4718
- Fax
- (817) 641-2960
- NPI assigned
- Feb 3, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | TX | Primary |
Addresses
Primary practice location
604 N Nolan River Rd
Cleburne, TX 76033-7008
Mailing address
604 N Nolan River Rd
Cleburne, TX 76033-7008
Phone (817) 645-4718
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 015900601 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391385600000",
"number": "1730502279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "604 N NOLAN RIVER RD",
"city": "CLEBURNE",
"state": "TX",
"postal_code": "760337008",
"telephone_number": "817-645-4718",
"fax_number": "817-641-2960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "604 N NOLAN RIVER RD",
"city": "CLEBURNE",
"state": "TX",
"postal_code": "760337008",
"telephone_number": "817-645-4718",
"fax_number": "817-641-2960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RURAK",
"first_name": "JACKIE (JACK)",
"middle_name": "DUWAYNE",
"name_prefix": "Mr.",
"credential": "ATP #64040",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-02-03",
"last_updated": "2014-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "TX",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "015900601",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleburne, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.