Provider Demographics
NPI:1447607270
Name:BW SPORTS PRACTICE, LLC
Entity Type:Organization
Organization Name:BW SPORTS PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:205-877-2663
Mailing Address - Fax:205-874-9622
Practice Address - Street 1:320 COOSA ST E
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2276
Practice Address - Country:US
Practice Address - Phone:205-877-2663
Practice Address - Fax:205-874-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies