Provider Demographics
NPI:1538343660
Name:HELEN SLACK INC
Entity type:Organization
Organization Name:HELEN SLACK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITTIE
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-872-9777
Mailing Address - Street 1:3111 MIDWESTERN PKWY
Mailing Address - Street 2:SUITE 156
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2816
Mailing Address - Country:US
Mailing Address - Phone:940-691-6111
Mailing Address - Fax:
Practice Address - Street 1:3111 MIDWESTERN PKWY
Practice Address - Street 2:SUITE 156
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2816
Practice Address - Country:US
Practice Address - Phone:940-691-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0517160001Medicare NSC