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General NPI Number Information
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NPI Number | 1417456583
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Entity Type | Organization
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Legal Business Name | BSA HOSPITAL, LLC
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 615 W HIGHWAY 60
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City | CANYON
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State | TX
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Zip | 79015-7302
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Country | US
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Telephone | 806-336-8042
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Fax |
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Provider Business Mailing Address
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Address Line | 615 W HIGHWAY 60
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City | CANYON
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State | TX
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Zip | 79015-7302
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Country | US
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Telephone | 806-655-7726
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Fax | 806-655-5529
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | STEPHEN C. PETROVICH
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Credential |
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Telephone | 615-296-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1000883
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License Number State | TX
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