Provider Demographics
NPI:1255391827
Name:COMMUNITY HOSPITAL OF BRAZOSPORT
Entity type:Organization
Organization Name:COMMUNITY HOSPITAL OF BRAZOSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:979-299-3236
Mailing Address - Street 1:194 ABNER JACKSON PKWY
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5160
Mailing Address - Country:US
Mailing Address - Phone:979-299-3236
Mailing Address - Fax:979-299-6407
Practice Address - Street 1:194 ABNER JACKSON PARKWAY
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5160
Practice Address - Country:US
Practice Address - Phone:979-299-3236
Practice Address - Fax:979-299-6407
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HOSPITAL OF BRAZOSPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-27
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003500251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458370OtherMEDICARE IDENTIFICATION #
TX458370Medicare ID - Type UnspecifiedPROVIDER NUMBER
TX00900Medicare UPIN