1629094651 NPI number — BRAZOS VALLEY PATHOLOGY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629094651 NPI number — BRAZOS VALLEY PATHOLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAZOS VALLEY PATHOLOGY, PLLC
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:
BVP
Provider Other Organization Name Type Code:
5
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:
1629094651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 163567
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78716-3567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-814-0298
Provider Business Mailing Address Fax Number:
512-597-2713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ST. JOSEPH HEALTH SYSTEM
Provider Second Line Business Practice Location Address:
2801 FRANCISCAN DR
Provider Business Practice Location Address City Name:
BRYAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-776-3777
Provider Business Practice Location Address Fax Number:
979-776-2406
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
BIRGIT
Authorized Official Middle Name:
Authorized Official Title or Position:
HR DIRECTOR
Authorized Official Telephone Number:
512-814-0298

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08010701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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