Provider Demographics
NPI:1093810913
Name:VALLEY BAPTIST MEDICAL CENTER
Entity Type:Organization
Organization Name:VALLEY BAPTIST MEDICAL CENTER
Other - Org Name:VALLEY BAPTIST RAYMONDVILLE DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:WESSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-389-1672
Mailing Address - Street 1:PO BOX 2588
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78551-2588
Mailing Address - Country:US
Mailing Address - Phone:956-389-1268
Mailing Address - Fax:956-389-4536
Practice Address - Street 1:894 FM 3168
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-4519
Practice Address - Country:US
Practice Address - Phone:956-689-9084
Practice Address - Fax:956-689-1951
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY BAPTIST HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-14
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007848261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
453505Medicare Oscar/Certification