Provider Demographics
NPI:1134169907
Name:VALLEY BAPTIST MANAGEMENT SERVICES CORPORATION
Entity type:Organization
Organization Name:VALLEY BAPTIST MANAGEMENT SERVICES CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT COO CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:EASTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-389-1604
Mailing Address - Street 1:PO BOX 2588
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78551-2588
Mailing Address - Country:US
Mailing Address - Phone:956-389-1776
Mailing Address - Fax:956-389-1137
Practice Address - Street 1:2121 PEASE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8348
Practice Address - Country:US
Practice Address - Phone:956-389-3800
Practice Address - Fax:956-389-3802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY BAPTIST HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164380102Medicare ID - Type UnspecifiedTEXAS PROVIDER IDENTIFIER
TXCL8535Medicare ID - Type UnspecifiedPROVIDER NUMBER