Provider Demographics
NPI:1235506429
Name:BIG COUNTRY AIDS SUPPORT GROUP
Entity Type:Organization
Organization Name:BIG COUNTRY AIDS SUPPORT GROUP
Other - Org Name:BIG COUNTRY AIDS RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGSTAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-672-3077
Mailing Address - Street 1:402 BUTTERNUT ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-1327
Mailing Address - Country:US
Mailing Address - Phone:325-672-3077
Mailing Address - Fax:888-602-9310
Practice Address - Street 1:402 BUTTERNUT ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-1327
Practice Address - Country:US
Practice Address - Phone:325-603-0691
Practice Address - Fax:888-602-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center