Provider Demographics
NPI:1154655801
Name:BAC WOMEN FRENCH
Entity Type:Organization
Organization Name:BAC WOMEN FRENCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-656-9999
Mailing Address - Street 1:1235 FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4808
Mailing Address - Country:US
Mailing Address - Phone:716-656-9999
Mailing Address - Fax:716-656-0736
Practice Address - Street 1:1235 FRENCH RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4808
Practice Address - Country:US
Practice Address - Phone:716-656-9999
Practice Address - Fax:716-656-0736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY585203001OtherBLUE CROSS CLUE SHIELD OF WESTERN NEW YORK