Provider Demographics
NPI:1609439884
Name:B & W HEALTHCARE, LLC
Entity Type:Organization
Organization Name:B & W HEALTHCARE, LLC
Other - Org Name:FAMILY HEALTHCARE OF BEDICO, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-320-7156
Mailing Address - Street 1:42378 OTT LN
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-3232
Mailing Address - Country:US
Mailing Address - Phone:985-320-7156
Mailing Address - Fax:
Practice Address - Street 1:27455 HIGHWAY 22 STE B
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-8107
Practice Address - Country:US
Practice Address - Phone:985-206-9877
Practice Address - Fax:985-206-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2194089Medicaid