Provider Demographics
NPI:1538933742
Name:BW MEDICAL LLC
Entity type:Organization
Organization Name:BW MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:601-410-0261
Mailing Address - Street 1:1888 MAIN ST STE C295
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6337
Mailing Address - Country:US
Mailing Address - Phone:601-668-3825
Mailing Address - Fax:
Practice Address - Street 1:203 CALHOUN STATION PARKWAY
Practice Address - Street 2:BUILDING 200, SUITE H
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110
Practice Address - Country:US
Practice Address - Phone:601-612-0510
Practice Address - Fax:601-612-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care