1831647155 NPI number — BRAZOS VALLEY COMMUNITY ACTION PROGRAMS

Table of content: ANITA C JAYNES CNM (NPI 1306894902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831647155 NPI number — BRAZOS VALLEY COMMUNITY ACTION PROGRAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAZOS VALLEY COMMUNITY ACTION PROGRAMS
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:
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:
1831647155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRYAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77805-4128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-595-2801
Provider Business Mailing Address Fax Number:
979-595-2810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 W 30TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77803-6923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-823-2203
Provider Business Practice Location Address Fax Number:
979-775-4277
Provider Enumeration Date:
09/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WILKINSON
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
979-595-2801

Provider Taxonomy Codes

  • Taxonomy code: 332U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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