Provider Demographics
NPI:1235185828
Name:BSA PHYSICIANS GROUP INC
Entity Type:Organization
Organization Name:BSA PHYSICIANS GROUP INC
Other - Org Name:BSA URGENT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HARPOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-212-6965
Mailing Address - Street 1:PO BOX 840026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0026
Mailing Address - Country:US
Mailing Address - Phone:806-212-6965
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:4510 S BELL ST
Practice Address - Street 2:URGENT CARE CENTER
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109
Practice Address - Country:US
Practice Address - Phone:806-212-4835
Practice Address - Fax:806-212-6278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2018-05-17
Deactivation Date:2017-11-02
Deactivation Code:
Reactivation Date:2018-03-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D0055097OtherCLIA NUMBER
TX4874220001Medicare NSC