Provider Demographics
NPI:1629094651
Name:BRAZOS VALLEY PATHOLOGY, PLLC
Entity Type:Organization
Organization Name:BRAZOS VALLEY PATHOLOGY, PLLC
Other - Org Name:BVP
Other - Org Type:Other Name
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BIRGIT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-814-0298
Mailing Address - Street 1:PO BOX 163567
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-3567
Mailing Address - Country:US
Mailing Address - Phone:512-814-0298
Mailing Address - Fax:512-597-2713
Practice Address - Street 1:ST. JOSEPH HEALTH SYSTEM
Practice Address - Street 2:2801 FRANCISCAN DR
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802
Practice Address - Country:US
Practice Address - Phone:979-776-3777
Practice Address - Fax:979-776-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX08010701Medicaid
TX00576NMedicare PIN