Healthcare Provider Details

I. General information

NPI: 1568576056
Provider Name (Legal Business Name): BCA MEDICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 N WASHINGTON AVE
ROSWELL NM
88201-3941
US

IV. Provider business mailing address

813 N WASHINGTON AVE
ROSWELL NM
88201-3941
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-2606
  • Fax: 575-622-6645
Mailing address:
  • Phone: 575-622-2606
  • Fax: 575-622-6645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROE VANDENBOUT
Title or Position: OFFICE MANAGER
Credential:
Phone: 575-622-2606