1154440949 NPI number — B.C.C. INC.APCC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154440949 NPI number — B.C.C. INC.APCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B.C.C. INC.APCC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154440949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 W AIRLINE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PLACE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70068-3816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-653-8903
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 N STATE LINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75503-3132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-792-3763
Provider Business Practice Location Address Fax Number:
903-792-6898
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BLOUIN
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
W
Authorized Official Title or Position:
INSURANCE SUPERVISOR
Authorized Official Telephone Number:
985-653-8903

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  7000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 91929 . This is a "AR BLUE CROO" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1217457-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128823718 . This is a "AR MEDICAID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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