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General NPI Number Information
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NPI Number | 1114414406
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Entity Type | Organization
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Legal Business Name | BWG MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 1311 SUNDIAL PT
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-6622
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Country | US
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Telephone | 321-888-3325
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Fax | 844-239-2996
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Provider Business Mailing Address
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Address Line | 1311 SUNDIAL PT
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-6622
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Country | US
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Telephone | 321-888-3325
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Fax | 844-239-2996
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Authorized Official
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Title or Position | DIRECTOR
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Name | NICHOLAS SAVAS
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Credential |
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Telephone | 321-888-3325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 10D2144401
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License Number State | FL
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