Provider Demographics
NPI:1942893391
Name:BLACK BRONCO CONSTRUCTION
Entity Type:Organization
Organization Name:BLACK BRONCO CONSTRUCTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FIRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-313-7374
Mailing Address - Street 1:6770 LAUFFER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-1676
Mailing Address - Country:US
Mailing Address - Phone:614-313-7374
Mailing Address - Fax:
Practice Address - Street 1:6770 LAUFFER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-1676
Practice Address - Country:US
Practice Address - Phone:614-313-7374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty