Provider Demographics
NPI:1548475643
Name:VALLEY BAPTIST MEDICAL CENTER
Entity type:Organization
Organization Name:VALLEY BAPTIST MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:956-389-2451
Mailing Address - Street 1:P.O. DRAWER 2588
Mailing Address - Street 2:4405 GLASSCOCK AVE
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78551-2588
Mailing Address - Country:US
Mailing Address - Phone:956-389-2450
Mailing Address - Fax:956-389-2434
Practice Address - Street 1:4405 GLASSCOCK AVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-9209
Practice Address - Country:US
Practice Address - Phone:956-389-2450
Practice Address - Fax:956-389-2434
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY BAPTIST MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-11
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16640261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX250402Medicaid
TX750457OtherBCBS
TX1002600001Medicare ID - Type Unspecified