Provider Demographics
NPI:1033638069
Name:BDS HEALTHCARE LLC
Entity Type:Organization
Organization Name:BDS HEALTHCARE LLC
Other - Org Name:VYBREM LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER/OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROSSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-888-8099
Mailing Address - Street 1:1321 VALWOOD PKWY STE 660
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6889
Mailing Address - Country:US
Mailing Address - Phone:469-221-9405
Mailing Address - Fax:877-670-0124
Practice Address - Street 1:1311 FORT ST STE M
Practice Address - Street 2:
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-2045
Practice Address - Country:US
Practice Address - Phone:469-221-9405
Practice Address - Fax:877-670-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR04D2132998291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR04D2132998OtherCLIA