Provider Demographics
NPI:1396084380
Name:BCS ALLERGY & ASTHMA
Entity type:Organization
Organization Name:BCS ALLERGY & ASTHMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GANESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANMUGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-703-6112
Mailing Address - Street 1:1602 ROCK PRAIRIE RD
Mailing Address - Street 2:STE 270
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8306
Mailing Address - Country:US
Mailing Address - Phone:979-703-6112
Mailing Address - Fax:979-703-6649
Practice Address - Street 1:1602 ROCK PRAIRIE RD
Practice Address - Street 2:STE 270
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8306
Practice Address - Country:US
Practice Address - Phone:979-703-6112
Practice Address - Fax:979-703-6649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6388207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281346Medicare PIN