Provider Demographics
NPI:1811994122
Name:BCBU, INC.
Entity type:Organization
Organization Name:BCBU, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BANGERTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-397-4000
Mailing Address - Street 1:576 W. 900 S.
Mailing Address - Street 2:SUITE 260
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8127
Mailing Address - Country:US
Mailing Address - Phone:801-397-4600
Mailing Address - Fax:801-397-4196
Practice Address - Street 1:175 RIVER VIEW DR STE A
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-4811
Practice Address - Country:US
Practice Address - Phone:307-875-7976
Practice Address - Fax:307-875-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY05164251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY112546000Medicaid
303938OtherBLUE CROSS BLUE SHIELD OF WYOMING
IA537302Medicare Oscar/Certification