Provider Demographics
NPI:1568576056
Name:BCA MEDICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:BCA MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDENBOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-622-2606
Mailing Address - Street 1:813 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3941
Mailing Address - Country:US
Mailing Address - Phone:575-622-2606
Mailing Address - Fax:575-622-6645
Practice Address - Street 1:813 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3941
Practice Address - Country:US
Practice Address - Phone:575-622-2606
Practice Address - Fax:575-622-6645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty