Provider Demographics
NPI:1366852519
Name:BW FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:BW FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OMOWUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINRULI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-401-0606
Mailing Address - Street 1:6212 EMERALDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7826
Mailing Address - Country:US
Mailing Address - Phone:302-401-0606
Mailing Address - Fax:
Practice Address - Street 1:1201 N MARKET ST STE 111
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1156
Practice Address - Country:US
Practice Address - Phone:302-401-0606
Practice Address - Fax:214-433-6327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
DEC1-0009779261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty