Provider Demographics
NPI:1205971553
Name:BCW ENTERPRISE
Entity type:Organization
Organization Name:BCW ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-518-1669
Mailing Address - Street 1:118 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1724
Mailing Address - Country:US
Mailing Address - Phone:682-518-1669
Mailing Address - Fax:817-473-1839
Practice Address - Street 1:118 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1724
Practice Address - Country:US
Practice Address - Phone:682-518-1669
Practice Address - Fax:817-473-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty