Basic Information
| Provider Information | |||||||||
| NPI: | 1619270188 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY BAPTIST MEDICAL CENTER - BROWNSVILLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 W JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785206338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566985400 | ||||||||
| FaxNumber: | 9566985583 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 W JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785206338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566985400 | ||||||||
| FaxNumber: | 9566985583 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2010 | ||||||||
| LastUpdateDate: | 12/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | BINGHAM | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. VICE PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 9566985800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VALLEY BAPTIST HEALTH SYSTEM | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 000314 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1652414-05 | 05 | TX | MEDICAID |