Provider Demographics
NPI:1891297941
Name:BACC AND ASSOCIATES
Entity Type:Organization
Organization Name:BACC AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-494-6590
Mailing Address - Street 1:13918 E MISSISSIPPI AVE # 206
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3603
Mailing Address - Country:US
Mailing Address - Phone:719-494-6590
Mailing Address - Fax:
Practice Address - Street 1:2421 W WILLAMETTE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2660
Practice Address - Country:US
Practice Address - Phone:719-494-6590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95-135-3538343900000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)