Provider Demographics
NPI:1467632737
Name:ALLIANCE HEALTH PROVIDERS OF THE BRAZOS VALLEY
Entity Type:Organization
Organization Name:ALLIANCE HEALTH PROVIDERS OF THE BRAZOS VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:RHU
Authorized Official - Phone:979-846-2489
Mailing Address - Street 1:1328 MEMORIAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5237
Mailing Address - Country:US
Mailing Address - Phone:979-846-2489
Mailing Address - Fax:979-776-3026
Practice Address - Street 1:1328 MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5237
Practice Address - Country:US
Practice Address - Phone:979-846-2489
Practice Address - Fax:979-776-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization