Healthcare Provider Details

I. General information

NPI: 1164807616
Provider Name (Legal Business Name): BD2 PREVENTATIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 COUNTRY COVE CIR
CLINTON MS
39056-9632
US

IV. Provider business mailing address

201 COUNTRY COVE CIR
CLINTON MS
39056-9632
US

V. Phone/Fax

Practice location:
  • Phone: 601-575-3392
  • Fax: 769-218-0849
Mailing address:
  • Phone: 601-575-3392
  • Fax: 769-218-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateMS

VIII. Authorized Official

Name: BARBARA BRADLEY
Title or Position: MEMBER
Credential:
Phone: 601-575-3392