Provider Demographics
NPI:1396842068
Name:VALLEY BAPTIST MANAGEMENT SERVICES CORPORATION
Entity Type:Organization
Organization Name:VALLEY BAPTIST MANAGEMENT SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:EASTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-389-1604
Mailing Address - Street 1:PO BOX 2588
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78551-2588
Mailing Address - Country:US
Mailing Address - Phone:956-389-1268
Mailing Address - Fax:956-389-4536
Practice Address - Street 1:2325 S 77 SUNSHINE STRIP
Practice Address - Street 2:SUITE B
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8355
Practice Address - Country:US
Practice Address - Phone:956-412-9100
Practice Address - Fax:956-412-9105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0029325332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX913428-01Medicaid
TX913428-01Medicaid