Provider Demographics
NPI:1346585809
Name:BSA HARRINGTON PHYSICIANS INC
Entity Type:Organization
Organization Name:BSA HARRINGTON PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-296-3000
Mailing Address - Street 1:PO BOX 840048
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0048
Mailing Address - Country:US
Mailing Address - Phone:806-212-5079
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:1751 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1711
Practice Address - Country:US
Practice Address - Phone:806-212-4673
Practice Address - Fax:806-212-0057
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BSA PHYSICIAN HOLDING COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-10
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136269114Medicaid
TX330222YNR6OtherMEDICARE