Provider Demographics
NPI:1205371812
Name:BCONNECTED
Entity Type:Organization
Organization Name:BCONNECTED
Other - Org Name:HEALTHTRUST
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:J
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-685-0484
Mailing Address - Street 1:21427 COZY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5663
Mailing Address - Country:US
Mailing Address - Phone:601-685-0484
Mailing Address - Fax:
Practice Address - Street 1:21427 COZY HOLLOW LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5663
Practice Address - Country:US
Practice Address - Phone:601-685-0484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHTRUST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS876934282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109326485OtherBCONNECTED
TX109326485Medicare PIN