Provider Demographics
NPI:1164807616
Name:BD2 PREVENTATIVE SERVICES LLC
Entity Type:Organization
Organization Name:BD2 PREVENTATIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-575-3392
Mailing Address - Street 1:201 COUNTRY COVE CIR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-9632
Mailing Address - Country:US
Mailing Address - Phone:601-575-3392
Mailing Address - Fax:769-218-0849
Practice Address - Street 1:201 COUNTRY COVE CIR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-9632
Practice Address - Country:US
Practice Address - Phone:601-575-3392
Practice Address - Fax:769-218-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory