Provider Demographics
NPI:1962401885
Name:B-CS FAMILY MEDICINE CLINIC P A
Entity type:Organization
Organization Name:B-CS FAMILY MEDICINE CLINIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:I
Authorized Official - Last Name:HAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-776-7513
Mailing Address - Street 1:2010 E VILLA MARIA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2540
Mailing Address - Country:US
Mailing Address - Phone:979-776-7513
Mailing Address - Fax:979-776-7515
Practice Address - Street 1:2010 E VILLA MARIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2540
Practice Address - Country:US
Practice Address - Phone:979-776-7513
Practice Address - Fax:979-776-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2221174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081366901Medicaid
TX0091AKMedicare PIN