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General NPI Number Information
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NPI Number | 1235506429
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Entity Type | Organization
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Legal Business Name | BIG COUNTRY AIDS SUPPORT GROUP
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 402 BUTTERNUT ST
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City | ABILENE
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State | TX
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Zip | 79602-1327
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Country | US
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Telephone | 325-603-0691
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Fax | 888-602-9310
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Provider Business Mailing Address
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Address Line | 402 BUTTERNUT ST
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City | ABILENE
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State | TX
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Zip | 79602-1327
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Country | US
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Telephone | 325-672-3077
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Fax | 888-602-9310
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JAMES WAGSTAFF
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Credential |
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Telephone | 325-672-3077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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