Provider Demographics
NPI:1144438086
Name:BRAZOS VALLEY MEDICAL EQUIPMENT, INC.
Entity type:Organization
Organization Name:BRAZOS VALLEY MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICEPRESIDENTANDMANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHENNAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-348-5709
Mailing Address - Street 1:2644 DERBY LN
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77864-4110
Mailing Address - Country:US
Mailing Address - Phone:936-348-5709
Mailing Address - Fax:936-348-5358
Practice Address - Street 1:2644 DERBY LN
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TX
Practice Address - Zip Code:77864-4110
Practice Address - Country:US
Practice Address - Phone:936-348-5709
Practice Address - Fax:936-348-5358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0041089332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000517267OtherBLUE CROSS BLUE SHIELD
TX0619180001Medicare ID - Type Unspecified