Provider Demographics
NPI:1386045185
Name:BRAZOS VALLEY HOSPITAL, LLC
Entity Type:Organization
Organization Name:BRAZOS VALLEY HOSPITAL, LLC
Other - Org Name:CAPROCK 24 HOUR EMERGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VENUTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-284-1678
Mailing Address - Street 1:948 WILLIAM D FITCH
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845
Mailing Address - Country:US
Mailing Address - Phone:979-314-2323
Mailing Address - Fax:979-314-2360
Practice Address - Street 1:948 WILLIAM D FITCH
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845
Practice Address - Country:US
Practice Address - Phone:979-314-2323
Practice Address - Fax:979-314-2360
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAZOS VALLEY HOSPITAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-11
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160141OtherDEPARTMENT OF STATE HEALTH SERVICES