Provider Demographics
NPI:1336514306
Name:BW SPORTS PRACTICE, LLC
Entity Type:Organization
Organization Name:BW SPORTS PRACTICE, LLC
Other - Org Name:BROOKWOOD SPORTS AND ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-5009
Mailing Address - Street 1:PO BOX 742727
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2727
Mailing Address - Country:US
Mailing Address - Phone:205-988-8311
Mailing Address - Fax:205-777-4888
Practice Address - Street 1:2547 JOHN HAWKINS PKWY
Practice Address - Street 2:STE. 103
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3554
Practice Address - Country:US
Practice Address - Phone:205-988-8311
Practice Address - Fax:205-777-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies