Provider Demographics
NPI:1780799502
Name:BSA PHYSICIANS GROUP INC
Entity type:Organization
Organization Name:BSA PHYSICIANS GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HARPOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-212-6965
Mailing Address - Street 1:6 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4136
Mailing Address - Country:US
Mailing Address - Phone:806-353-6604
Mailing Address - Fax:806-359-0938
Practice Address - Street 1:6 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-353-6604
Practice Address - Fax:806-359-0938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2018-05-17
Deactivation Date:2017-11-02
Deactivation Code:
Reactivation Date:2018-03-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000MT10OtherBCBS GROUP
TX00MT10Medicare ID - Type Unspecified