Provider Demographics
NPI:1407163660
Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC
Entity Type:Organization
Organization Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC
Other - Org Name:ROCK PRAIRIE FAMILY MEDICINE AND OB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-846-1100
Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:#100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:1602 ROCK PRAIRIE RD
Practice Address - Street 2:#230
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8308
Practice Address - Country:US
Practice Address - Phone:979-693-2586
Practice Address - Fax:979-693-9047
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-09
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217213201Medicaid
1821185299OtherNPI AGENCY
TX671953Medicare Oscar/Certification