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General NPI Number Information
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NPI Number | 1861934473
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Entity Type | Organization
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Legal Business Name | BCS HEALTHCARE, LLC
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 300 N 100 W
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City | MALAD CITY
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State | ID
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Zip | 83252-1144
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Country | US
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Telephone | 208-766-3776
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Fax |
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Provider Business Mailing Address
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Address Line | 300 N 100 W
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City | MALAD CITY
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State | ID
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Zip | 83252-1144
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Country | US
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Telephone | 208-766-3776
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRENT SCHOW
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Credential | NP
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Telephone | 208-766-3776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 54136
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License Number State | ID
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