Provider Demographics
NPI:1679877641
Name:BELLVILLE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:BELLVILLE GENERAL HOSPITAL
Other - Org Name:MEDICAL CLINIC OF BELLVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-865-3141
Mailing Address - Street 1:235 W PALM ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BELLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77418-1372
Mailing Address - Country:US
Mailing Address - Phone:979-865-0100
Mailing Address - Fax:979-865-1611
Practice Address - Street 1:235 W PALM ST
Practice Address - Street 2:SUITE 108
Practice Address - City:BELLVILLE
Practice Address - State:TX
Practice Address - Zip Code:77418-1372
Practice Address - Country:US
Practice Address - Phone:979-865-3141
Practice Address - Fax:979-865-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085587602Medicaid
TX085587603Medicaid
TX085587601Medicaid
TX085587602Medicaid