Provider Demographics
NPI:1477761377
Name:BERNARD L. ROUSCH, MD
Entity Type:Organization
Organization Name:BERNARD L. ROUSCH, MD
Other - Org Name:MID-CITIES PSYCHIATRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-285-8081
Mailing Address - Street 1:111 BEDFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-5222
Mailing Address - Country:US
Mailing Address - Phone:817-285-8081
Mailing Address - Fax:
Practice Address - Street 1:111 BEDFORD RD STE B
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5222
Practice Address - Country:US
Practice Address - Phone:817-285-8081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00M068Medicare ID - Type Unspecified