Provider Demographics
NPI:1104314665
Name:BCW GROUP LLC
Entity type:Organization
Organization Name:BCW GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CESSNUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-380-4462
Mailing Address - Street 1:803 GALLAGHER DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1750
Mailing Address - Country:US
Mailing Address - Phone:903-747-1644
Mailing Address - Fax:
Practice Address - Street 1:1903 W ARKANSAS ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-5625
Practice Address - Country:US
Practice Address - Phone:580-380-4462
Practice Address - Fax:903-408-6441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies