Provider Demographics
NPI:1750735692
Name:BCL MEDICAL, LLC
Entity type:Organization
Organization Name:BCL MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENTLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-234-9859
Mailing Address - Street 1:2146 W 1100 S
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-6991
Mailing Address - Country:US
Mailing Address - Phone:801-234-9859
Mailing Address - Fax:801-217-3898
Practice Address - Street 1:2146 W 1100 S
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-6991
Practice Address - Country:US
Practice Address - Phone:801-234-9859
Practice Address - Fax:801-217-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT16048332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies