Healthcare Provider Details

I. General information

NPI: 1730429952
Provider Name (Legal Business Name): BJC HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 ROWENA ST
MONTGOMERY LA
71454
US

IV. Provider business mailing address

641 ROWENA STREET
MONTGOMERY LA
71454-3636
US

V. Phone/Fax

Practice location:
  • Phone: 318-646-3000
  • Fax:
Mailing address:
  • Phone: 318-646-3000
  • Fax: 318-646-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateLA

VIII. Authorized Official

Name: MATTHEW SIGLER
Title or Position: PMC
Credential:
Phone: 318-201-5321