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Author: Admin | 2025-04-28
4 = former legal business name; 5 = other. Provider First Line Business Mailing Address PO BOX 160 The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''. Provider Business Mailing Address City Name BREMOND The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''. Provider Business Mailing Address State Name TX The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''. Provider Business Mailing Address Postal Code 76629-0160 The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''. Provider Business Mailing Address Country Code US The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''. Provider Business Mailing Address Telephone Number 254-746-7845 The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''. Provider Business Mailing Address Fax Number 254-746-7370 The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider
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