Provider Demographics
NPI:1790592004
Name:BIG BEND MEDICAL GROUP
Entity type:Organization
Organization Name:BIG BEND MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PHYSICIAN SERVICES FINANCIAL OPS
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3641
Mailing Address - Street 1:1573 MALLORY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2895
Mailing Address - Country:US
Mailing Address - Phone:615-221-3722
Mailing Address - Fax:
Practice Address - Street 1:2301 S GREGG ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5531
Practice Address - Country:US
Practice Address - Phone:432-267-5531
Practice Address - Fax:432-268-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health