Basic Information
| Provider Information | |||||||||
| NPI: | 1295839991 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRIM HEALTHCARE OF TEXAS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 PINE ST | ||||||||
| Address2: | ATTN: BILLING | ||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755015100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037988000 | ||||||||
| FaxNumber: | 9037988030 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 PINE ST | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755015100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037988000 | ||||||||
| FaxNumber: | 9037987725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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| AuthorizedOfficialLastName: | GILBERT | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | HOSPITAL CEO | ||||||||
| AuthorizedOfficialTelephone: | 9037988001 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BRIM HEALTHCARE OF TEXAS LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 45S200 | TX | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 2073116-04 | 05 | TX | MEDICAID |