Provider Demographics
NPI:1184695686
Name:BCMI INC
Entity type:Organization
Organization Name:BCMI INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-542-4990
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:NEW STANTON
Mailing Address - State:PA
Mailing Address - Zip Code:15672-0450
Mailing Address - Country:US
Mailing Address - Phone:724-542-4990
Mailing Address - Fax:724-542-4981
Practice Address - Street 1:6207 RTE 30
Practice Address - Street 2:SUITE 1030
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6444
Practice Address - Country:US
Practice Address - Phone:724-830-8140
Practice Address - Fax:724-830-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012671420001Medicaid
PA1730275OtherHIGHMARK BCBS
PA1730275OtherHIGHMARK BCBS