Provider Demographics
NPI:1508019811
Name:BMCD S.P.O.R.T.S. LLC.
Entity Type:Organization
Organization Name:BMCD S.P.O.R.T.S. LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDEN
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, SCS
Authorized Official - Phone:810-656-0565
Mailing Address - Street 1:3675 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIAVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48421-9338
Mailing Address - Country:US
Mailing Address - Phone:810-656-0565
Mailing Address - Fax:810-653-6226
Practice Address - Street 1:3675 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIAVILLE
Practice Address - State:MI
Practice Address - Zip Code:48421-9338
Practice Address - Country:US
Practice Address - Phone:810-656-0565
Practice Address - Fax:810-653-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6211880001Medicare NSC