Provider Demographics
NPI:1710417761
Name:BRAZOS VALLEY ER, LLC
Entity Type:Organization
Organization Name:BRAZOS VALLEY ER, LLC
Other - Org Name:PHYSICIANS PREMIER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MEMBER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-991-0912
Mailing Address - Street 1:PO BOX 61041
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1041
Mailing Address - Country:US
Mailing Address - Phone:361-884-2904
Mailing Address - Fax:
Practice Address - Street 1:2411 BOONVILLE RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-2231
Practice Address - Country:US
Practice Address - Phone:979-775-0911
Practice Address - Fax:512-825-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care