Provider Demographics
NPI:1154089548
Name:BCW GROUP LLC
Entity Type:Organization
Organization Name:BCW GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CESSNUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-380-4462
Mailing Address - Street 1:803 GALLAGHER DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1750
Mailing Address - Country:US
Mailing Address - Phone:903-747-1644
Mailing Address - Fax:903-408-6441
Practice Address - Street 1:803 GALLAGHER DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1750
Practice Address - Country:US
Practice Address - Phone:903-747-1644
Practice Address - Fax:903-408-6441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BCW GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4116196Medicaid
OK200866750AMedicaid