=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659762334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BACAS MEDICAL MANAGEMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2015
-----------------------------------------------------
Last Update Date | 02/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8619 BROADWAY ST STE. 205
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584-8782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-461-4300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3333 ALLEN PKWY SUITE 2001
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77019-1854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. NELSON BOND
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 404-502-1155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | L4253
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------