Provider Demographics
NPI:1821185299
Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Entity type:Organization
Organization Name:BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-596-5852
Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-810-8148
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:1500 UNIVERSITY DR E
Practice Address - Street 2:#100
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-2600
Practice Address - Country:US
Practice Address - Phone:979-846-1100
Practice Address - Fax:979-260-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1568519122OtherNPI L
TX1700973187OtherNPI G
TX187842302Medicaid
TX000951607Medicaid
TX1750470084OtherNPI M
TX1912056730OtherNPI PHARM
TX1275726853OtherNPI CS
TX187842301Medicaid
TX21721320Medicaid
TX1275620551OtherNPI ROBERTSON CHC
TX154467801Medicaid
TX154467803Medicaid
TX1649265646OtherNPI BCS
TX1407163660OtherROCK PRAIRIE FAMILY MEDICINE AND OBSTETRICS-NPI
TX185649401Medicaid
TX000951608Medicaid
TX1043527476OtherCOLLEGE STATION FAMILY MEDICINE CLINIC - NPI
TX1811171580OtherNPI MEDICAID GROUP OB BILLING
TX671953Medicare Oscar/Certification
TX1649265646OtherNPI BCS
TX187842301Medicaid
TX185649401Medicaid
TX154467803Medicaid
TX000951607Medicaid
TX21721320Medicaid
TX451942Medicare Oscar/Certification