Healthcare Provider Details

I. General information

NPI: 1609112069
Provider Name (Legal Business Name): BSA HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WALLACE BLVD
AMARILLO TX
79106-1799
US

IV. Provider business mailing address

1 BURTON HILLS BLVD SUITE 250
NASHVILLE TN
37215-6293
US

V. Phone/Fax

Practice location:
  • Phone: 806-212-2000
  • Fax: 806-212-8836
Mailing address:
  • Phone: 615-296-3000
  • Fax: 615-296-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN C PETROVICH
Title or Position: SVP
Credential:
Phone: 615-296-3000