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General NPI Number Information
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NPI Number | 1205371812
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Entity Type | Organization
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Legal Business Name | BCONNECTED
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 21427 COZY HOLLOW LN
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City | RICHMOND
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State | TX
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Zip | 77469-5663
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Country | US
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Telephone | 601-685-0484
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Fax |
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Provider Business Mailing Address
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Address Line | 21427 COZY HOLLOW LN
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City | RICHMOND
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State | TX
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Zip | 77469-5663
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Country | US
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Telephone | 601-685-0484
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Fax |
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Authorized Official
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Title or Position | PATIENT
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Name | ALISON J JENKINS
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Credential |
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Telephone | 601-685-0484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | 876934
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License Number State | MS
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