Healthcare Provider Details

I. General information

NPI: 1780044545
Provider Name (Legal Business Name): FCI BIG SPRING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SIMLER AVE
BIG SPRING TX
79720-7789
US

IV. Provider business mailing address

1900 SIMLER AVE
BIG SPRING TX
79720-7789
US

V. Phone/Fax

Practice location:
  • Phone: 432-466-2438
  • Fax:
Mailing address:
  • Phone: 432-466-2438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TELEISA CRNKOVICH
Title or Position: HEALTH SERVICES ADMINISTRATOR
Credential: HSA
Phone: 432-466-2300