Provider Demographics
NPI:1497574917
Name:BIR HOSPITAL LLC
Entity type:Organization
Organization Name:BIR HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBODH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:MALLIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-290-2510
Mailing Address - Street 1:800 E DICKINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-4318
Mailing Address - Country:US
Mailing Address - Phone:432-336-9711
Mailing Address - Fax:
Practice Address - Street 1:800 E DICKINSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-4318
Practice Address - Country:US
Practice Address - Phone:432-336-9711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care