Provider Demographics
NPI:1366864605
Name:BAC ACUTE SURGICAL CARE INC
Entity Type:Organization
Organization Name:BAC ACUTE SURGICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-623-4104
Mailing Address - Street 1:2536 RIMROCK AVE
Mailing Address - Street 2:SUITE 400-321
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-8669
Mailing Address - Country:US
Mailing Address - Phone:970-623-4104
Mailing Address - Fax:970-644-5399
Practice Address - Street 1:2478 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-3605
Practice Address - Country:US
Practice Address - Phone:970-623-4104
Practice Address - Fax:970-644-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR45880208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97431761Medicaid