Provider Demographics
NPI:1477857332
Name:BELLVILLE MEDICAL CENTER
Entity Type:Organization
Organization Name:BELLVILLE MEDICAL CENTER
Other - Org Name:MID COAST MEDICAL CLINIC-BELLVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-543-6251
Mailing Address - Street 1:PO BOX 977
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77418
Mailing Address - Country:US
Mailing Address - Phone:979-413-7400
Mailing Address - Fax:979-413-7190
Practice Address - Street 1:44 N. CUMMINGS ST.
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:TX
Practice Address - Zip Code:77418
Practice Address - Country:US
Practice Address - Phone:979-413-7400
Practice Address - Fax:979-413-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 208600000X, 208C00000X
TX00552282N00000X
TX100210282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
45U253OtherSWING BED
TX0832909-06Medicaid
TX0832909-04Medicaid
TX0832909-05Medicaid
TX083290905Medicaid
TX45U253OtherSWING BED
TX083290905Medicaid
TX45U253Medicare Oscar/Certification
450253Medicare Oscar/Certification