1295764330 NPI number — BAPTIST HOSPITALS OF SOUTHEAST TEXAS

Table of content: (NPI 1295764330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295764330 NPI number — BAPTIST HOSPITALS OF SOUTHEAST TEXAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST HOSPITALS OF SOUTHEAST TEXAS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEMORIAL HERMANN BAPTIST ORANGE HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295764330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 974599
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75397-4599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-212-6149
Provider Business Mailing Address Fax Number:
409-212-6063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 STRICKLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77630-4717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-212-6149
Provider Business Practice Location Address Fax Number:
409-212-6063
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARMER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
409-212-5012

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  000121 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 136488705 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 500013 . This is a "MHHNP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 450005 . This is a "WORKMANCOMP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 136488703 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136488705 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0495 . This is a "BLUE CROSS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1731943 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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