Provider Demographics
NPI:1386918365
Name:BIG COUNTRY ENTERPRISES, INC.
Entity type:Organization
Organization Name:BIG COUNTRY ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-236-6351
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-0008
Mailing Address - Country:US
Mailing Address - Phone:325-235-7608
Mailing Address - Fax:325-236-6336
Practice Address - Street 1:502 S AVENUE F
Practice Address - Street 2:
Practice Address - City:KNOX CITY
Practice Address - State:TX
Practice Address - Zip Code:79529-2110
Practice Address - Country:US
Practice Address - Phone:940-657-3210
Practice Address - Fax:940-657-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX278143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5905318OtherNCPDP PROVIDER IDENTIFICATION NUMBER