Basic Information
| Provider Information | |||||||||
| NPI: | 1699746073 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIG SPRING HOSPITAL CORPORATION | ||||||||
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| OtherOrganizationName: | SCENIC MOUNTAIN MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 844854 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752844854 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 W 11TH PL | ||||||||
| Address2: | |||||||||
| City: | BIG SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797204114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4322631211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 04/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDSON | ||||||||
| AuthorizedOfficialFirstName: | TARA | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | VP PATIENT FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 6152213672 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BIG SPRING HOSPITAL CORPORATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 000221 | TX | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | HO4556538 | 05 | TX | MEDICAID | HH0013 | 01 | BCBS | OTHER |