Provider Demographics
NPI:1427710896
Name:B&W MEDICAL SOLUTIONS LLC
Entity type:Organization
Organization Name:B&W MEDICAL SOLUTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:719-661-6033
Mailing Address - Street 1:3332 W MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1019
Mailing Address - Country:US
Mailing Address - Phone:334-246-2577
Mailing Address - Fax:949-561-5764
Practice Address - Street 1:3332 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1019
Practice Address - Country:US
Practice Address - Phone:719-661-6033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty