Provider Demographics
NPI:1790577583
Name:BCI GROUP LLC
Entity type:Organization
Organization Name:BCI GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:575-491-5367
Mailing Address - Street 1:4 DOMINION DRIVE, BLDG 4
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1488
Mailing Address - Country:US
Mailing Address - Phone:210-850-5790
Mailing Address - Fax:
Practice Address - Street 1:17316 N KIMBERLY WAY
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-9686
Practice Address - Country:US
Practice Address - Phone:575-491-5367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty