Provider Demographics
NPI:1386743573
Name:VALLEY BAPTIST MEDICAL CENTER
Entity type:Organization
Organization Name:VALLEY BAPTIST MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. V.P. & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WESSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-389-1672
Mailing Address - Street 1:P.O. DRAWER 2588
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78551-2588
Mailing Address - Country:US
Mailing Address - Phone:956-389-2060
Mailing Address - Fax:956-389-2017
Practice Address - Street 1:2101 PEASE STREET
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8307
Practice Address - Country:US
Practice Address - Phone:956-389-1672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY BAPTIST HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000400273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0659336Medicaid
TN25216Medicaid
IA09404235Medicaid
WA3150604Medicaid
CO95500336Medicaid
WI80578700Medicaid
TX450033OtherTWCC WORKERS COMP
TXHH0062OtherBC-BS OF TX
WA3150604Medicaid
TX=========OtherHSPC PPO / TTC PPO
TN25216Medicaid
CO95500336Medicaid
TX=========OtherUNICARE
IA09404235Medicaid