Provider Demographics
NPI:1114414406
Name:BWG MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:BWG MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-888-3325
Mailing Address - Street 1:1311 SUNDIAL PT
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-6622
Mailing Address - Country:US
Mailing Address - Phone:321-888-3325
Mailing Address - Fax:844-239-2996
Practice Address - Street 1:1311 SUNDIAL PT
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6622
Practice Address - Country:US
Practice Address - Phone:321-888-3325
Practice Address - Fax:844-239-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2144401291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2144401OtherCMS-CLIA