1477857332 NPI number — BELLVILLE MEDICAL CENTER

Table of content: (NPI 1477857332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477857332 NPI number — BELLVILLE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLVILLE MEDICAL CENTER
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:
MID COAST MEDICAL CLINIC-BELLVILLE
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:
1477857332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 977
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-413-7400
Provider Business Mailing Address Fax Number:
979-413-7190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44 N. CUMMINGS ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-413-7400
Provider Business Practice Location Address Fax Number:
979-413-7190
Provider Enumeration Date:
01/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MAK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
979-543-6251

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 00552 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 100210 , 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: 45U253 . This is a "SWING BED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0832909-06 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0832909-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0832909-05 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 083290905 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45U253 . This is a "SWING BED" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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