1356312243 NPI number — BIG BEND HOSPITAL CORPORATION

Table of content: (NPI 1356312243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356312243 NPI number — BIG BEND HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIG BEND HOSPITAL CORPORATION
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:
BIG BEND REGIONAL MEDICAL CENTER
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:
1356312243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 846339
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:
75284-6339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 N HIGHWAY 118
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALPINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79830-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-837-3447
Provider Business Practice Location Address Fax Number:
432-837-0330
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
TARA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
615-221-3672

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 180925600 . This is a "WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 063340601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 094224502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107754701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 450830 . This is a "AETNA OP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000A6881 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0504 . This is a "BC FED" identifier . This identifiers is of the category "OTHER".
  • Identifier: B50830 . This is a "AETNA IP" identifier . This identifiers is of the category "OTHER".
  • Identifier: HH0504 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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