MEDICARE: BDS HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	04D2132998	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04D2132998	OTHER	AR	CLIA

General Provider Information

NPI Number	:	1033638069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BDS HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1321 VALWOOD PKWY STE 660
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-6889
Country	:	US
Telephone Number	:	469-221-9405
Fax Number	:	877-670-0124

Provider Business Practice Location Address
First Line	:	1311 FORT ST STE M
Second Line	:
City	:	BARLING
State	:	AR
Zip	:	72923-2045
Country	:	US
Telephone Number	:	469-221-9405
Fax Number	:	877-670-0124

Authorized Official
Title or Position	:	GENERAL PARTNER/OFFICER
Name	:	MR. CARY K ROSSEL
Credential	:
Telephone Number	:	214-888-8099

Provider Enumeration Date	:	09/11/2017
Last Update Date	:	09/14/2017

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Directions to “BDS HEALTHCARE LLC ” Practice Location

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