1821475591 NPI number — BHH OF GREGG COUNTY AND REGION, 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 1821475591 NPI number — BHH OF GREGG COUNTY AND REGION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BHH OF GREGG COUNTY AND REGION, 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:
1821475591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 LEGACY DR STE 360
Provider Second Line Business Mailing Address:
SUITE 360
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75024-3116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-248-2441
Provider Business Mailing Address Fax Number:
972-248-0773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 W LOOP 281
Provider Second Line Business Practice Location Address:
SUITE 440
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75605-4653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-553-0056
Provider Business Practice Location Address Fax Number:
903-553-9383
Provider Enumeration Date:
05/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LASSITER
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
972-248-2441

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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