Provider Demographics
NPI:1336920743
Name:BC MEDICAL
Entity Type:Organization
Organization Name:BC MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:501-388-6689
Mailing Address - Street 1:505 S ELM ST STE C
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6604
Mailing Address - Country:US
Mailing Address - Phone:501-388-6689
Mailing Address - Fax:949-695-2638
Practice Address - Street 1:505 S ELM ST STE C
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6604
Practice Address - Country:US
Practice Address - Phone:501-388-6689
Practice Address - Fax:949-695-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care