1801912050 NPI number — BIG COUNTRY HEALTHCARE SERVICES LLC

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 1801912050 NPI number — BIG COUNTRY HEALTHCARE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIG COUNTRY HEALTHCARE SERVICES LLC
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:
Provider Other Organization Name Type Code:
6
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:
1801912050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
749 GATEWAY ST. BUILDING F
Provider Second Line Business Mailing Address:
SUITE 702
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79602-1196
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-675-0559
Provider Business Mailing Address Fax Number:
325-675-0591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
749 GATEWAY ST. BUILDING F
Provider Second Line Business Practice Location Address:
SUITE 702
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79602-1196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-675-0559
Provider Business Practice Location Address Fax Number:
325-675-0591
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUDSON
Authorized Official First Name:
JOHNNIE
Authorized Official Middle Name:
CHRISTINE
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
325-675-0559

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  010529 , 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)





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