Provider Demographics
NPI:1558516583
Name:BIG BEND HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:BIG BEND HOSPITAL CORPORATION
Other - Org Name:BIG BEND REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTH OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:PO BOX 846339
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6339
Mailing Address - Country:US
Mailing Address - Phone:432-837-3447
Mailing Address - Fax:
Practice Address - Street 1:2600 N HIGHWAY 118
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-2002
Practice Address - Country:US
Practice Address - Phone:432-837-3447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIG BEND HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007119275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45Z378Medicare Oscar/Certification