1629068341 NPI number — BWDC MEDICAL EQUIPMENT CO.

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 1629068341 NPI number — BWDC MEDICAL EQUIPMENT CO.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BWDC MEDICAL EQUIPMENT CO.
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:
BYRD WATSON MEDICAL EQUIP CO
Provider Other Organization Name Type Code:
3
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:
1629068341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 N LOCUST ST
Provider Second Line Business Mailing Address:
PO BOX 1747
Provider Business Mailing Address City Name:
CENTRALIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62801-3242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-532-3045
Provider Business Mailing Address Fax Number:
618-533-0572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 N LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62801-5303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-532-3045
Provider Business Practice Location Address Fax Number:
618-533-0572
Provider Enumeration Date:
10/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BREEZE
Authorized Official First Name:
WESLEY
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER PRES
Authorized Official Telephone Number:
618-532-3045

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  203000105 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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