Provider Demographics
NPI:1295839991
Name:BRIM HEALTHCARE OF TEXAS LLC
Entity Type:Organization
Organization Name:BRIM HEALTHCARE OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-798-8001
Mailing Address - Street 1:1000 PINE ST
Mailing Address - Street 2:ATTN: BILLING
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5100
Mailing Address - Country:US
Mailing Address - Phone:903-798-8000
Mailing Address - Fax:903-798-8030
Practice Address - Street 1:1000 PINE ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5100
Practice Address - Country:US
Practice Address - Phone:903-798-8000
Practice Address - Fax:903-798-7725
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIM HEALTHCARE OF TEXAS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-12
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45S200273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2073116-04Medicaid
45S200Medicare Oscar/Certification