Provider Demographics
NPI:1124603402
Name:BCP 1, LLC
Entity Type:Organization
Organization Name:BCP 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BARRETT
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-513-0882
Mailing Address - Street 1:2490 PARR AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2030
Mailing Address - Country:US
Mailing Address - Phone:731-285-0844
Mailing Address - Fax:
Practice Address - Street 1:2490 PARR AVE STE 9
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2030
Practice Address - Country:US
Practice Address - Phone:731-285-0844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty