NPIMap

Organization Active NPI

Temple Memorial Pediatric Center Inc.

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Texarkana, TX
National Provider Identifier
1972654663
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
License
009425 Issued in TX
Legal business name
TEMPLE MEMORIAL PEDIATRIC CENTER INC.
Practice address
1710 Moores LN
Texarkana, TX 75503-1858
Phone
(903) 794-2705
Fax
(903) 793-1203
NPI assigned
Jan 16, 2007
Last updated
Apr 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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

Authorized official

Name
Mrs. Sandra K Varner
Title
Ceo
Phone
(903) 794-2705

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X 009425 TX Primary
Behavior Analyst 103K00000X NU

Addresses

Primary practice location

1710 Moores LN
Texarkana, TX 75503-1858

Mailing address

1710 Moores LN
Texarkana, TX 75503-1858
Phone (903) 794-2705

Other identifiers 4

IdentifierTypeStateIssuer
021289601MedicaidTX
8P097OtherTXARKANSAS BCBS
116506742MedicaidAR
00T7468OtherTXBCBS OF TEXAS

Other names 1

  • Temple Memorial Rehabilitation Center Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100416000600 TX Part A Provider - Comprehensive Outpatient Rehabilitation Facility 8224949870 Practice locations: Texarkana, TX

National Provider Directory

National Provider Directory
Tax ID family
Brazos Valley Rehabilitation Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1315 Walnut St
Texarkana, TX 75501
Phone (903) 794-2705

1710 Moores Ln
Texarkana, TX 75503
Phone (903) 794-2705

6307 Richmond Rd
Texarkana, TX 75503
Phone (903) 458-9591

Practitioners & affiliated clinicians

Practitioners 63

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1972654663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 MOORES LN",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755031858",
            "telephone_number": "903-794-2705",
            "fax_number": "903-793-1203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 MOORES LN",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755031858",
            "telephone_number": "903-794-2705",
            "fax_number": "903-793-1203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEMPLE MEMORIAL PEDIATRIC CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "VARNER",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "903-794-2705",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "TX",
            "license": "009425",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021289601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS BCBS",
            "identifier": "8P097",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116506742",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "00T7468",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temple Memorial Rehabilitation Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Texarkana, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.