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General NPI Number Information
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NPI Number | 1568600195
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Entity Type | Organization
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Legal Business Name | ALLEGIANCE HEALTH CENTER OF MIDLAND, LLC
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 04/09/2010
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Provider Practice Location Address
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Address Line | 207 TRADEWINDS BLVD
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City | MIDLAND
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State | TX
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Zip | 79706-2807
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Country | US
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Telephone | 432-520-1401
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Fax | 432-529-1215
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Provider Business Mailing Address
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Address Line | 504 TEXAS ST STE 200
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City | SHREVEPORT
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State | LA
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Zip | 71101-3526
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Country | US
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Telephone | 318-226-8202
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Fax | 318-226-8205
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Authorized Official
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Title or Position | CEO
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Name | MR. ROCK BORDELON
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Credential |
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Telephone | 318-226-8202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State | TX
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